Individual- and Regional-level determinants of Human Papillomavirus (HPV) vaccine refusal: the Ontario Grade 8 HPV vaccine cohort study
| Autor: | Olivia Remes, Lindsey Colley, Leah M Smith, Beatriz Alvarado-Llano, Linda E. Lévesque |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Vaccine coverage Canada Human papillomavirus medicine.medical_specialty Adolescent Cohort Studies Treatment Refusal Epidemiology Humans Medicine Papillomavirus Vaccines Papillomaviridae Child Poverty Vaccine hesitancy Retrospective Studies HPV vaccine Ontario biology business.industry Public health Papillomavirus Infections Vaccination Public Health Environmental and Occupational Health Censuses Retrospective cohort study Patient Acceptance of Health Care biology.organism_classification Immunology Cohort Female business Research Article Demography Cohort study |
| Zdroj: | BMC Public Health |
| ISSN: | 1471-2458 |
| DOI: | 10.1186/1471-2458-14-1047 |
| Popis: | Background Studies on the determinants of human papillomavirus (HPV) vaccine use have generally focused on individual-level characteristics, despite the potentially important influence of regional-level characteristics. Therefore, we undertook a population-based, retrospective cohort study to identify individual- and regional-level determinants of HPV vaccine refusal (non-receipt) in Ontario’s (Canada) Grade 8 HPV Immunization Program. Methods Ontario’s administrative health and immunization databases were used to identify girls eligible for free HPV vaccination in 2007–2011 and to ascertain individual-level characteristics of cohort members (socio-demographics, vaccination history, health care utilization, medical history). The social and material characteristics of the girl’s region (health unit) were derived from the 2006 Canadian Census. Generalized estimating equations (binomial distribution, logit link) were used to estimate the population-average effects of individual- and regional-level characteristics on HPV vaccine refusal. Results Our cohort consisted of 144,047 girls, 49.3% of whom refused HPV vaccination. Factors associated with refusal included a previous diagnosis of Down’s syndrome (OR = 1.37, 95% CI 1.16-1.63) or autism (OR = 1.60, 95% CI 1.34-1.90), few physician visits (OR = 1.45, 95% CI 1.35-1.55), and previous refusal of mandatory (OR = 2.23, 95% CI 2.07-2.40) and optional (OR = 3.96, 95% CI 3.87-4.05) vaccines. Refusal was highest among the lowest and highest income levels. Finally, a previous diagnosis of obesity and living in an area of high deprivation were associated with lower refusal (OR = 0.87, 95% CI 0.83-0.92 and OR = 0.82 95%, CI 0.79-0.86, respectively). Conclusions Studies on HPV vaccine determinants should consider regional-level factors. Efforts to increase HPV vaccine acceptance should include vulnerable populations (such as girls of low income) and girls with limited contact with the healthcare system. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1047) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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