The impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland: reducing the gap

Ross L Cameron, Kimberley Kavanagh, D Cameron Watt, Chris Robertson, Kate Cuschieri, Syed Ahmed, Kevin G Pollock

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background: Cervical cancer disproportionately affects women from lower socio-economic backgrounds. A human papillomavirus (HPV) vaccination programme was introduced in Scotland in 2008 with uptake being lower and inequitable in a catch-up cohort run for the first three years of the programme compare to the routine programme. The socio-economic differences in vaccine uptake have the potential to further increase the inequality gap in regards to cervical disease. Methods: Vaccination status was linked to demographical, cytological and colposcopic data, which is routinely collected by the Scottish HPV surveillance system. Incidence rates and relative risk of cervical intraepithelial neoplasia (CIN) 1, 2 and 3 in unvaccinated and vaccinated women were stratified by birth year and deprivation status using Poisson regression. Results: Women who received three doses of HPV vaccine have significantly decreased risk of CIN 1, 2 and 3. Vaccine effectiveness was greater in those women from the most deprived backgrounds against CIN 2 and 3 lesions. Compared to the most deprived, unvaccinated women, the relative risk of CIN3 in fully vaccinated women in the same deprivation group was 0.29 (95% CI 0.2-0.43) compared to 0.62 (95% CI 0.4-0.97) in vaccinated women in the least deprived group. Conclusions: The HPV vaccine is associated with significant reductions in both low- and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most deprived women. These data are welcoming and allays the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland.
Conclusions: The HPV vaccine is associated with significant reductions in both low- and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most deprived women. These data are welcoming and allays the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland.
LanguageEnglish
Pages954-960
Number of pages7
JournalJournal of Epidemiology and Community Health
Volume71
Issue number10
Early online date29 Jul 2017
DOIs
Publication statusPublished - 31 Oct 2017

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Papillomavirus Vaccines
Cervical Intraepithelial Neoplasia
Scotland
Vaccines
Uterine Cervical Neoplasms
Vaccination
Economics
Parturition

Keywords

  • cervical cancer
  • human papillomavirus (HPV)
  • vaccination
  • vaccination programmes
  • f cervical intraepithelial neoplasia (CIN)

Cite this

@article{27ee320fbaab431b9a6c00a244c1123e,
title = "The impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland: reducing the gap",
abstract = "Background: Cervical cancer disproportionately affects women from lower socio-economic backgrounds. A human papillomavirus (HPV) vaccination programme was introduced in Scotland in 2008 with uptake being lower and inequitable in a catch-up cohort run for the first three years of the programme compare to the routine programme. The socio-economic differences in vaccine uptake have the potential to further increase the inequality gap in regards to cervical disease. Methods: Vaccination status was linked to demographical, cytological and colposcopic data, which is routinely collected by the Scottish HPV surveillance system. Incidence rates and relative risk of cervical intraepithelial neoplasia (CIN) 1, 2 and 3 in unvaccinated and vaccinated women were stratified by birth year and deprivation status using Poisson regression. Results: Women who received three doses of HPV vaccine have significantly decreased risk of CIN 1, 2 and 3. Vaccine effectiveness was greater in those women from the most deprived backgrounds against CIN 2 and 3 lesions. Compared to the most deprived, unvaccinated women, the relative risk of CIN3 in fully vaccinated women in the same deprivation group was 0.29 (95{\%} CI 0.2-0.43) compared to 0.62 (95{\%} CI 0.4-0.97) in vaccinated women in the least deprived group. Conclusions: The HPV vaccine is associated with significant reductions in both low- and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most deprived women. These data are welcoming and allays the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland. Conclusions: The HPV vaccine is associated with significant reductions in both low- and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most deprived women. These data are welcoming and allays the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland.",
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The impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland : reducing the gap. / Cameron, Ross L; Kavanagh, Kimberley; Cameron Watt, D; Robertson, Chris; Cuschieri, Kate; Ahmed, Syed; Pollock, Kevin G.

In: Journal of Epidemiology and Community Health, Vol. 71, No. 10, 31.10.2017, p. 954-960.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact of bivalent HPV vaccine on cervical intraepithelial neoplasia by deprivation in Scotland

T2 - Journal of Epidemiology and Community Health

AU - Cameron, Ross L

AU - Kavanagh, Kimberley

AU - Cameron Watt, D

AU - Robertson, Chris

AU - Cuschieri, Kate

AU - Ahmed, Syed

AU - Pollock, Kevin G

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2017/10/31

Y1 - 2017/10/31

N2 - Background: Cervical cancer disproportionately affects women from lower socio-economic backgrounds. A human papillomavirus (HPV) vaccination programme was introduced in Scotland in 2008 with uptake being lower and inequitable in a catch-up cohort run for the first three years of the programme compare to the routine programme. The socio-economic differences in vaccine uptake have the potential to further increase the inequality gap in regards to cervical disease. Methods: Vaccination status was linked to demographical, cytological and colposcopic data, which is routinely collected by the Scottish HPV surveillance system. Incidence rates and relative risk of cervical intraepithelial neoplasia (CIN) 1, 2 and 3 in unvaccinated and vaccinated women were stratified by birth year and deprivation status using Poisson regression. Results: Women who received three doses of HPV vaccine have significantly decreased risk of CIN 1, 2 and 3. Vaccine effectiveness was greater in those women from the most deprived backgrounds against CIN 2 and 3 lesions. Compared to the most deprived, unvaccinated women, the relative risk of CIN3 in fully vaccinated women in the same deprivation group was 0.29 (95% CI 0.2-0.43) compared to 0.62 (95% CI 0.4-0.97) in vaccinated women in the least deprived group. Conclusions: The HPV vaccine is associated with significant reductions in both low- and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most deprived women. These data are welcoming and allays the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland. Conclusions: The HPV vaccine is associated with significant reductions in both low- and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most deprived women. These data are welcoming and allays the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland.

AB - Background: Cervical cancer disproportionately affects women from lower socio-economic backgrounds. A human papillomavirus (HPV) vaccination programme was introduced in Scotland in 2008 with uptake being lower and inequitable in a catch-up cohort run for the first three years of the programme compare to the routine programme. The socio-economic differences in vaccine uptake have the potential to further increase the inequality gap in regards to cervical disease. Methods: Vaccination status was linked to demographical, cytological and colposcopic data, which is routinely collected by the Scottish HPV surveillance system. Incidence rates and relative risk of cervical intraepithelial neoplasia (CIN) 1, 2 and 3 in unvaccinated and vaccinated women were stratified by birth year and deprivation status using Poisson regression. Results: Women who received three doses of HPV vaccine have significantly decreased risk of CIN 1, 2 and 3. Vaccine effectiveness was greater in those women from the most deprived backgrounds against CIN 2 and 3 lesions. Compared to the most deprived, unvaccinated women, the relative risk of CIN3 in fully vaccinated women in the same deprivation group was 0.29 (95% CI 0.2-0.43) compared to 0.62 (95% CI 0.4-0.97) in vaccinated women in the least deprived group. Conclusions: The HPV vaccine is associated with significant reductions in both low- and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most deprived women. These data are welcoming and allays the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland. Conclusions: The HPV vaccine is associated with significant reductions in both low- and high-grade CIN for all deprivation categories. However, the effect on high-grade disease was most profound in the most deprived women. These data are welcoming and allays the concern that inequalities in cervical cancer may persist or increase following the introduction of the vaccine in Scotland.

KW - cervical cancer

KW - human papillomavirus (HPV)

KW - vaccination

KW - vaccination programmes

KW - f cervical intraepithelial neoplasia (CIN)

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U2 - 10.1136/jech-2017-209113

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JO - Journal of Epidemiology and Community Health

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SN - 0143-005X

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