Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Lancet Public Health. 2024 Sep;9(9):e674-e683. doi: 10.1016/S2468-2667(24)00182-8.
Despite documented mental illness-related disparities in cervical cancer screening and incidence, insufficient data exist on differences in cervical cancer prevention strategies, such as human papillomavirus (HPV) vaccination. We aimed to investigate the association of mental illness and neurodevelopmental conditions among girls and their parents with uptake of HPV vaccination in Sweden.
This population-based cohort study was based on the Swedish school-based HPV vaccination programme, which offers the first vaccine dose to girls aged 10-13 years, with a second dose offered within 12 months. We identified all girls born between Jan 1, 2002, and March 1, 2004, using the Swedish Total Population Register-ie, those eligible for two vaccine doses in the vaccination programme from its initiation in autumn 2012, to March, 2019. Nationwide Swedish register data (National Patient Register, Prescribed Drug Register, HPV Vaccination Register, National Vaccination Register, Total Population Register, Multi-Generation Register, Longitudinal Integrated Database for Health Insurance and Labour Market Studies, Education Register, National Cervical Screening Registry, and Cancer Register) were used to define individual and parental mental health conditions, including mental illness and neurodevelopmental conditions (defined by a clinical diagnosis and prescribed psychotropic medication use), HPV vaccine uptake (first and second dose), and sociodemographic and clinical characteristics. The two outcomes were uptake of the first HPV vaccine dose by the girl's 14th birthday and uptake of the second dose by the 15th birthday in relation to individual and parental mental health conditions, calculated using multivariable Poisson regression models.
115 104 girls were included in the study population. 2211 girls (1·9%) had a specialist diagnosis of any mental health condition. Uptake of the first HPV vaccine dose was 80·7% (92 912 of 115 104) and was lower among girls with versus without any mental health condition (adjusted relative risk 0·89 [95% CI 0·87-0·91]). The diagnosis of autism (0·79 [0·75-0·85]) or intellectual disability (0·78 [0·73-0·83]) were most strongly associated with lower HPV vaccine uptake. Vaccine uptake was also lower among girls with versus those without prescribed use of psychotropic medication (0·93 [0·92-0·95]), with the strongest association observed for antipsychotics (0·68 [0·56-0·82]). Uptake of the second dose was 95·0% (88 308 of 92 912), with no strong associations between uptake and mental health conditions in girls or their parents.
Our findings suggest disparities in cervical cancer prevention among girls with mental health conditions, and call for further research to ensure equitable protection.
Swedish Cancer Society.
尽管有文献记载精神疾病与宫颈癌筛查和发病存在差异，但关于宫颈癌预防策略（如人乳头瘤病毒[HPV]疫苗接种）方面的差异数据仍然不足。我们旨在研究女孩及其父母的精神疾病和神经发育状况与瑞典 HPV 疫苗接种率之间的关系。
本基于人群的队列研究基于瑞典学校HPV 疫苗接种计划，该计划为 10-13 岁女孩提供第一剂疫苗，并在 12 个月内提供第二剂疫苗。我们使用瑞典总人口登记册（即那些在 2012 年秋季开始的疫苗接种计划中符合接种两剂疫苗条件的人）确定了 2002 年 1 月 1 日至 2004 年 3 月 1 日之间出生的所有女孩，直至 2019 年 3 月。全国性的瑞典登记数据（国家患者登记册、处方药物登记册、HPV 疫苗接种登记册、国家疫苗接种登记册、总人口登记册、多代登记册、综合健康保险和劳动力市场研究的纵向综合数据库、教育登记册、国家宫颈癌筛查登记册和癌症登记册）用于定义个人和父母的心理健康状况，包括精神疾病和神经发育状况（通过临床诊断和规定的精神药物使用来定义）、HPV 疫苗接种（第一剂和第二剂）以及社会人口和临床特征。两个结果是女孩 14 岁生日时接种第一剂 HPV 疫苗的比例和女孩 15 岁生日时接种第二剂疫苗的比例，与个人和父母的心理健康状况有关，使用多变量泊松回归模型计算。
在研究人群中纳入了 115104 名女孩。2211 名女孩（1.9%）有任何精神健康状况的专家诊断。第一剂 HPV 疫苗接种率为 80.7%（115104 名中的 92912 名），且在有与无任何心理健康状况的女孩之间存在差异（调整后的相对风险 0.89 [95%CI 0.87-0.91]）。自闭症（0.79 [0.75-0.85]）或智力残疾（0.78 [0.73-0.83]）的诊断与 HPV 疫苗接种率最低有最强的相关性。与未使用精神药物处方的女孩相比，使用精神药物处方的女孩（0.93 [0.92-0.95]）的疫苗接种率也较低，而抗精神病药物的相关性最强（0.68 [0.56-0.82]）。第二剂疫苗接种率为 95.0%（92912 名中的 88308 名），但在女孩及其父母中，疫苗接种率与心理健康状况之间没有明显关联。
我们的研究结果表明，精神健康状况的女孩在宫颈癌预防方面存在差异，呼吁进一步研究以确保公平保护。
瑞典癌症协会。
