Abstract
IMPORTANCE: Although evaluation of geographic area inequities in vaccination is crucial to identify areas that need community-based interventions, knowledge of disparities in human papillomavirus (HPV) vaccination uptake remains limited in Japan. OBJECTIVE: To investigate the association of female cumulative HPV vaccination uptake with neighborhood-based socioeconomic status and access indicators in Osaka City, Japan. DESIGN, SETTING, AND PARTICIPANTS: This population-based, cross-sectional study included HPV vaccination data for fiscal year (April 1 to March 31) 2013 to fiscal year 2022 provided by Osaka City. The study population comprised the total number of girls eligible for HPV vaccination born between fiscal years 1997 and 2010. EXPOSURE: The area deprivation index (ADI) was used as a neighborhood-based socioeconomic status indicator, and the number of medical facilities providing HPV vaccination within a 500-m range of a representative point in each geographic area was used as an access indicator. MAIN OUTCOMES AND MEASURES: The primary outcome was cumulative uptake, defined as the cumulative number of girls receiving at least 1 dose and those completing all doses (3 doses until March 2023), by neighborhood ADI and access indicators. A Poisson regression model with robust variance was applied to assess the association of neighborhood-level indicators with cumulative HPV vaccination uptake. RESULTS: In Osaka City, 185 373 girls (median [IQR] age at vaccination, 16 [14-19] years) were eligible for HPV vaccination, of whom 18 688 (10.1%) received at least 1 dose of HPV vaccine. Compared with girls living in areas with the most deprivation (2539 of 28 078 [9.0%]), those living in areas with the least deprivation (4889 of 42 170 girls [11.6%]) had a greater cumulative HPV vaccination uptake (prevalence ratio [PR], 1.25; 95% CI, 1.16-1.34). In addition, compared with girls living in areas with low medical facility access (5128 of 55 055 [9.3%]), those residing in high-access areas (5862 of 54 740 [10.7%]) had a greater cumulative vaccination uptake (PR, 1.09; 95% CI, 1.03-1.16). Cumulative HPV vaccination was significantly associated with ADI in routine vaccination (least vs most deprivation: PR, 1.46; 95% CI, 1.33-1.61) but not in catch-up vaccination (least vs most deprivation: PR, 1.01; 95% CI, 0.92-1.11). CONCLUSIONS AND RELEVANCE: In this cross-sectional study of area deprivation, vaccination access, and HPV vaccination status, higher socioeconomic status and higher medical facility access were associated with higher cumulative HPV vaccination uptake. These findings suggest that further strategies, including a socioecologic approach, are needed to increase HPV vaccination and reduce disparities in uptake.