title: Papillomavirus vaccine coverage and its determinants in South-Eastern France.
abstract: OBJECTIVE
  We wanted: (i) to assess vaccine coverage (VC) for papillomavirus (HPV) (one and three doses of the vaccine, VC1 and VC3) and compliance with the recommended vaccination regimen (3rd dose within 1 year after the 1st dose) among 14-16 year-old girls; and (ii) to identify the factors independently associated with VC and compliance with the recommended vaccination regimen.
  
  
  METHODS
  We conducted a descriptive longitudinal study, using the National Health Insurance reimbursement database, for years 2007 to 2009, in South-Eastern France. We performed a multivariate analysis (Cox proportional hazards model).
  
  
  RESULTS
  VC1 was 35.5%, with 68.8% of those who started vaccination having completed the 3-dose regimen, 64.1% within one year. VC1 and VC3 were positively associated with the girl's age. Girls covered by the complementary social welfare healthcare program and those living in rural areas had lower VC1 and VC3. Being covered by the complementary social welfare healthcare program was also associated with lower compliance with the recommended vaccination regimen. VC1 and VC3 were positively associated with the number of medical consultations during the study period. Important geographical variations were noted regarding VC1.
  
  
  CONCLUSIONS
  Our study confirms that VC for HPV is insufficient in our region, and that there are socio-economic and geographical inequalities. Even though the vaccine is reimbursed for all girls, efforts must be made to improve VC, particularly for girls covered by the complementary social welfare healthcare program and those living in rural areas.
authors.affiliation: Inserm, U912, SESSTIM, 13006 Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Lions
authors.forename: C
authors.initials: C
authors.lastname: Pulcini
authors.forename: P
authors.initials: P
authors.lastname: Verger
mesh_terms: D000293:Adolescent; D000367:Age Factors; D005260:Female; D005602:France; D006801:Humans; D007115:Immunization Schedule; D007117:Immunization, Secondary / Q000191:economics / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement; D053918:Papillomavirus Vaccines / Q000008:administration & dosage / Q000145:classification / Q000191:economics; D010349:Patient Compliance / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012946:Social Welfare; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D014611:Vaccination / Q000191:economics / Q000706:statistics & numerical data*
chemical_list: D053918:Papillomavirus Vaccines