JMIR Publications

ABSTRACT

Background:

Human papillomavirus (HPV) infection causes nearly all cervical cancer cases and is a cause of anogenital and oropharyngeal cancers. The incidence of HPV-associated cancers is inequitable, with an increased burden in marginalized groups in high-income countries. Understanding how immunization status varies by material and social deprivation, health system, and geospatial factors is valuable for prioritizing and planning HPV immunization interventions.

Objective:

The objective of this study was to describe school-based HPV immunization rates by individual and geospatial determinants of health in Alberta, Canada. This was achieved by (1) understanding variation in HPV immunization uptake in relation to determinants of health within individual and geographic area level analyses; and (2) identifying clusters of regions with a higher or lower percent of individuals without full HPV immunization and comparing distribution of individual determinants of health across those regions.

Methods:

Health administrative data for males and females born in 2004 in Alberta was used to determine HPV immunization status based on age and the number of doses administered in schools during the 2014/2015-2018/2019 school years. Immunization status and its relationship with material and social deprivation and health system factors was assessed by a logistic regression model. Geospatial clustering was assessed using Getis-Ord Gi* hot-spot analysis. Mean scores of material and social deprivation and health system factors were compared between hot and cold spots without full HPV immunization using independent samples t-tests. A multi-disciplinary team comprised of researchers and knowledge users formed a co-design team to design the study protocol and review study results.

Results:

The cohort consisted of 45,207 youth. In the adjusted model, those who did not see their general practitioner (GP) within three years prior to turning ten years old were more likely to be not fully immunized than those who did see their GP (aOR=1.965, 95% CI=1.855-2.080). Health system users with health conditions (aOR=1.092, 95% CI=1.006-1.185) and health system non-users (aOR=1.831, 95% CI=1.678-1.998) were more likely to be not fully immunized than health system users without health conditions. Those who lived in areas with the most material (aOR=1.287, 95% CI=1.200-1.381) and social deprivation (aOR=1.099, 95% CI=1.029-1.174) were more likely to be not fully immunized than those who lived in areas with the least deprivation. Those who lived in rural areas were more likely to be not fully immunized than those who lived in urban areas (aOR=1.428, 95% CI=1.359-1.501). Significant hot-spot clusters of individuals without full HPV immunization exist in rural locations on the North and East sides of Alberta. Hot spots had significantly worse mean material deprivation scores (P=.008) and fewer GP visits (P=.001) compared to cold spots.

Conclusions:

Findings suggest that material and social deprivation, health system access, and rural residency impact HPV immunization. Such factors should be considered by public health professionals in other jurisdictions and will be used by the Alberta co-design team when tailoring programs to increase HPV vaccine uptake in priority populations and regions.