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HPV 疫苗接种方式与疫苗接种公平性:一项全国性队列研究。

Mode of HPV vaccination delivery and equity in vaccine uptake: A nationwide cohort study.

机构信息

Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 65 Stockholm, Sweden; Dept. of Laboratory Medicine, Karolinska Institutet, SE-141 86 Stockholm, Sweden.

Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 65 Stockholm, Sweden.

出版信息

Prev Med. 2019 Mar;120:26-33. doi: 10.1016/j.ypmed.2018.12.014. Epub 2018 Dec 27.

Abstract

Ten years after its introduction, equity in human papillomavirus (HPV) vaccine uptake remains unattained, not least for the groups at highest risk of cervical cancer. In Sweden, three different delivery modes of the vaccine have been in effect since May 2007. We used this as a natural experiment to investigate girls' HPV vaccine uptake in relation to parental country of birth and socioeconomic characteristics, by mode of delivery. Our nationwide study cohort comprised 689,676 girls born between 1990 and 2003. Data on HPV vaccination of the girls and parental birth/socioeconomic characteristics were retrieved from national registers. We examined the association between girls' vaccine uptake and parental characteristics, stratified by mode of delivery. The cumulative uptake of at least one dose of HPV vaccine was 37%, 48% and 79% for subsidised opportunistic, free-of-charge catch-up outside-school and free-of-charge school-based vaccination, respectively. In the subsidised vaccination, having parents born outside of Sweden, with low education and low family income was strongly associated with lower uptake [HR (95% confidence interval (CI)) = 0.49 (0.48-0.50), 0.32 (0.31-0.33), 0.53 (0.52-0.54), respectively]. The associations were partially reduced in catch-up outside-school, and strongly reduced in school-based vaccination delivery [HR (95% CI) =0.82 (0.81-0.83), 0.92 (0.91-0.94), 0.87 (0.85-0.88), respectively]. Free-of-charge school-based HPV vaccination achieved the highest uptake and displayed the least disparity in country of birth and socioeconomic background of the parents. This appears to be the most effective and equitable delivery mode for reaching high population vaccination coverage, including high-risk groups for cervical cancer.

摘要

HPV 疫苗接种的公平性在推出十年后仍未实现,尤其是在宫颈癌高危人群中。自 2007 年 5 月以来,瑞典已经实施了三种不同的疫苗接种方式。我们利用这一自然实验,通过接种方式,研究了女孩 HPV 疫苗接种与父母出生国和社会经济特征的关系。我们的全国性研究队列包括 1990 年至 2003 年期间出生的 689676 名女孩。从国家登记处检索了女孩 HPV 疫苗接种和父母出生/社会经济特征的数据。我们根据接种方式,对女孩疫苗接种率与父母特征之间的关系进行了分层分析。在补贴的机会性接种、校外免费补种和校内免费接种中,至少接种一剂 HPV 疫苗的累计接种率分别为 37%、48%和 79%。在补贴接种中,父母出生在瑞典以外、教育程度低、家庭收入低的女孩接种率较低[风险比(95%置信区间)=0.49(0.48-0.50)、0.32(0.31-0.33)、0.53(0.52-0.54)]。在校外补种中,这些关联有所减弱,在校内接种中,关联明显减弱[风险比(95%置信区间)=0.82(0.81-0.83)、0.92(0.91-0.94)、0.87(0.85-0.88)]。免费的校内 HPV 疫苗接种实现了最高的接种率,并且在父母的出生国和社会经济背景方面的差异最小。这似乎是实现高人群疫苗接种率的最有效和公平的接种方式,包括宫颈癌高危人群。

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