Ethnic background and human papillomavirus vaccine uptake in Denmark: A countrywide retrospective cohort study including 274,154 women aged 19–28 years

Abstract

Aim: We examined ethnicity-related differences in the uptake of a temporary free-of-charge HPV vaccine (HPVV) catch-up programme offered in Denmark from August 2012 to December 2013 to women born from 1985–1992 and compared it with the previous self-payment system in place. Methods: We conducted a nationwide retrospective cohort study. We performed logistic regression analyses to examine the relationship between ethnic background and HPV vaccine (HPVV) programme initiation. Results: The free programme increased the vaccination uptake from 16% to 75%. Descendants (Denmark-born women with both parents of foreign origin) and immigrants in Denmark for more than 5 years were less likely to initiate the free HPVV programme than Denmark-born women ((aOR=0.56; 95% CI: 0.54–0.59) and (aOR=0.39; 95% CI: 0.38–0.40), respectively). The likelihood of HPVV programme initiation among immigrants increased with time in Denmark ((aOR=2.28; 95% CI: 2.11–2.48) for immigrants living in Denmark for 16–20 years compared to 6–10 years)). Conclusion: The initiation of the free-of-charge HPVV programme was satisfactory. However, large differences in uptake were demonstrated, indicating that some target groups are harder to reach than others. The integration process (as related to use of health services) occurs over many years where differences between the different population groups seem to vanish. Keywords: HPV, Human papillomavirus, Vaccine, Uptake, Ethnic background, Initiation