Examining inequalities in the uptake of the school-based HPV vaccination programme in England: a retrospective cohort study

J Public Health (Oxf). 2014 Mar;36(1):36-45. doi: 10.1093/pubmed/fdt042. Epub 2013 Apr 25.


Background: Although uptake of Human Papillomavirus (HPV) vaccine is high in the United Kingdom, it is unknown whether the programme has been delivered equitably by ethnicity or deprivation. This study aimed to investigate factors associated with HPV vaccine initiation and completion within the routine HPV vaccination programme in the South West of England.

Methods: Data were retrieved for young women eligible for routine vaccination from 2008/09 to 2010/11 from three Primary Care Trusts (PCTs)/local authorities. Multivariable logistic regression models were developed to examine factors associated with uptake of HPV vaccination.

Results: Of 14 282 eligible young women, 12 658 (88.6%) initiated, of whom 11 725 (92.6%) completed the course. Initiation varied by programme year (86.5-89.6%) and PCTs/local authorities (84.8-91.6%). There was strong evidence for an overall difference of initiation by ethnicity (P < 0.001), but not deprivation quintile (P = 0.48). Young women educated in non-mainstream educational settings were less likely to initiate and, if initiated, less likely to complete (both P < 0.001).

Conclusions: HPV vaccination uptake did not vary markedly by social deprivation. However, associations with ethnicity and substantially lower uptake in non-mainstream educational settings were observed. Research to identify reasons for low vaccine uptake in these population groups is required.

Keywords: United Kingdom; adolescent health; HPV vaccine; inequalities; school-based.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Educational Status
  • England / epidemiology
  • Female
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Papillomavirus Vaccines / therapeutic use*
  • Racial Groups / statistics & numerical data
  • Retrospective Studies
  • School Health Services / statistics & numerical data*


  • Papillomavirus Vaccines