Vaccine · 2025
Socioeconomic deprivation and human papillomavirus vaccination inequities: evidence from Southern Italy.
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Fiorilla Claudio, Contarino Fabio, Sorrentino Michele, Bella Francesca, Leonforte Francesco, Nicosia Vito, Mistretta Antonio, Montuori Paolo, Palladino Raffaele
Аннотация
BACKGROUND: Human papillomavirus is the most prevalent sexually transmitted infection globally and a leading cause of anogenital and oropharyngeal cancers. In Italy, despite the availability of a free HPV vaccination program since 2007 for girls and since 2018 for boys, national coverage remains below the 95 % target, with marked territorial and gender-based disparities. This study aims to assess the relationship between socioeconomic deprivation and HPV vaccination coverage within the Siracusa province, Sicily.
METHODS: An ecological time-series study was conducted using aggregated, anonymized data from the regional vaccination registry. Vaccination outcomes included full-cycle completion and first-dose initiation, stratified by sex, birth cohort, and municipality. Socioeconomic deprivation was measured using a composite index based on education level, employment status, housing conditions, and family structure, derived from national census data. Multilevel Poisson regression models were applied to account for Local Health Unity and municipal variability.
RESULTS: HPV vaccination coverage showed substantial geographic variability. Municipalities such as Augusta reported the highest rates, while more deprived areas like Priolo Gargallo had significantly lower uptake. A consistent gender gap emerged across all locations, with males displaying significantly lower coverage than females. Multivariate analysis revealed a significant inverse association between deprivation and vaccination uptake, particularly for first-dose administration. A marked decline in coverage across successive birth cohorts was also observed, and receiving the first dose at an older age was strongly associated with lower completion rates.
CONCLUSIONS: The findings underscore persistent inequities in HPV vaccine uptake driven by socioeconomic and demographic factors. Targeted strategies are urgently needed to address these disparities-particularly in deprived areas-and should include expanded school-based programs, gender-inclusive communication, and reminder-recall systems. Enhancing early vaccination, especially among boys and in disadvantaged communities, is essential to improving HPV prevention and achieving equitable public health outcomes.
METHODS: An ecological time-series study was conducted using aggregated, anonymized data from the regional vaccination registry. Vaccination outcomes included full-cycle completion and first-dose initiation, stratified by sex, birth cohort, and municipality. Socioeconomic deprivation was measured using a composite index based on education level, employment status, housing conditions, and family structure, derived from national census data. Multilevel Poisson regression models were applied to account for Local Health Unity and municipal variability.
RESULTS: HPV vaccination coverage showed substantial geographic variability. Municipalities such as Augusta reported the highest rates, while more deprived areas like Priolo Gargallo had significantly lower uptake. A consistent gender gap emerged across all locations, with males displaying significantly lower coverage than females. Multivariate analysis revealed a significant inverse association between deprivation and vaccination uptake, particularly for first-dose administration. A marked decline in coverage across successive birth cohorts was also observed, and receiving the first dose at an older age was strongly associated with lower completion rates.
CONCLUSIONS: The findings underscore persistent inequities in HPV vaccine uptake driven by socioeconomic and demographic factors. Targeted strategies are urgently needed to address these disparities-particularly in deprived areas-and should include expanded school-based programs, gender-inclusive communication, and reminder-recall systems. Enhancing early vaccination, especially among boys and in disadvantaged communities, is essential to improving HPV prevention and achieving equitable public health outcomes.