Human papillomavirus immunization uptake among girls with a refugee background compared with Danish-born girls: a national register-based cohort study.
Refugee children and their families may experience impaired access to healthcare; therefore, we aimed to uncover human papillomavirus (HPV) immunization patterns among a large group of refugee girls compared with Danish-born girls. We also examined possible predictors of uptake among refugee girls. We used a register-based cohort design where refugee girls (n=3264) who, between 1 January 1994 and 31 December 2010, obtained residency permits in Denmark, were included and matched on age and sex with Danish-born girls (n=19 584). Personal identification numbers were cross-linked to the National Danish Health Service Register, identifying all contacts for HPV-immunization in both the ordinary HPV-immunization program and in a catch-up program. We applied logistic regression to estimate the odds ratios (OR) of uptake. We found that refugee girls had significantly lower HPV immunization uptake compared with Danish-born girls in the ordinary immunization program (OR=0.44; 95% confidence interval: 0.37-0.51) and the catch-up program (OR=0.61; 95% confidence interval: 0.54-0.69). The difference in odds decreased after adjusting by family income, but remained significant for the ordinary immunization program. We also identified that region of origin, duration of residence, and income were predictors of uptake among refugee girls. The lower uptake of HPV immunization among refugee girls raises questions about the coverage of this immunization program across increasingly ethnic diverse societies. More efforts to secure equal uptake are needed.
Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen.
Sanne P
SP
Møller
Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen.
Maria
M
Kristiansen
Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health (MESU), Section for Health Services Research, University of Copenhagen.|Department of Infectious Diseases, Section of Immigrant Medicine, Copenhagen University Hospital, Copenhagen, Denmark.
Marie
M
Norredam
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012036:Refugees / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D014611:Vaccination / Q000706:statistics & numerical data*
D053918:Papillomavirus Vaccines