title: Socioeconomic inequalities to accessing vaccination against human papillomavirus in France: Results of the Health, Health Care and Insurance Survey, 2012.
abstract: BACKGROUND
  In France, human papillomavirus (HPV) vaccination coverage among adolescents and young women is low and decreasing. We analysed data from the 2012 Health, Health Care and Insurance Survey with the aim of identifying factors associated with this vaccination. We also compared the socioeconomic profile of unvaccinated young women to that of women who do not undergo cervical cancer screening (CCS).
  
  
  METHODS
  Data were collected through interviews and self-administered questionnaires completed by a randomised sample of Health insurance beneficiaries. Two analyses were performed using Poisson regression: one to investigate the determinants of CCS uptake in women aged 25-65 years old (n=4508), the other to investigate the determinants of HPV vaccination in young women aged 16-24 years old (n=899). A sub-analysis was performed in 685 "daughter-mother" couples from the same household in order to analyse the association between participation to CCS in mothers and HPV vaccination in daughters.
  
  
  RESULTS
  Factors significantly associated both to a lower CCS uptake and to an insufficient HPV vaccination were the lack of a complementary private health insurance (P=0.023 and P=0.037, respectively) and living in a family with a low household income (P<0.001 and P=0.005, respectively). A low education level was associated to a lower CCS uptake (P<0.001). The absence of CCS uptake in the last three years in mothers was associated to a lower level of HPV vaccination in their daughter (P=0.014).
  
  
  CONCLUSIONS
  Women who do not undergo CCS and HPV unvaccinated young women tend to be of modest socioeconomic status. Unvaccinated young females tend to have mothers who do not undergo CCS and are therefore at risk of benefiting from none of the two cervical cancer preventive measures. The current implementation strategy concerning HPV vaccination in France may therefore increase inequalities regarding cervical cancer prevention.
authors.affiliation: Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice Cedex, France. Electronic address: jean-paul.guthmann@santepubliquefrance.fr.
authors.forename: J-P
authors.initials: JP
authors.lastname: Guthmann
authors.affiliation: Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Pelat
authors.affiliation: Institut de recherche et documentation en économie de la santé, 117 bis, rue Manin, 75019 Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Célant
authors.affiliation: Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.
authors.forename: I
authors.initials: I
authors.lastname: Parent du Chatelet
authors.affiliation: Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Duport
authors.affiliation: Institut de recherche et documentation en économie de la santé, 117 bis, rue Manin, 75019 Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Rochereau
authors.affiliation: Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Lévy-Bruhl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007341:Insurance / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000276:immunology; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000627:therapeutic use*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines
keywords: Cervical cancer screening; Couverture vaccinale; Dépistage du cancer du col; Déterminants socioéconomiques; France; Human papillomavirus; Papillomavirus humain; Socioeconomic determinants; Vaccination coverage