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

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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.
Original languageEnglish
Pages (from-to)954-960
Number of pages7
JournalJournal of Epidemiology and Community Health
Volume71
Issue number10
Early online date29 Jul 2017
DOIs
Publication statusPublished - 31 Oct 2017

Keywords

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

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