Exploring variation in human papillomavirus vaccination uptake in Switzerland: a multilevel spatial analysis of a national vaccination coverage survey.

Riesen, Maurane; Konstantinoudis, Garyfallos; Lang, Phung; Low, Nicola; Hatz, Christoph; Maeusezahl, Mirjam; Spaar, Anne; Bühlmann, Marc; Spycher, Ben D; Althaus, Christian L (2018). Exploring variation in human papillomavirus vaccination uptake in Switzerland: a multilevel spatial analysis of a national vaccination coverage survey. BMJ open, 8(5), e021006. BMJ Publishing Group 10.1136/bmjopen-2017-021006

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OBJECTIVE Understanding the factors that influence human papillomavirus (HPV) vaccination uptake is critically important to the design of effective vaccination programmes. In Switzerland, HPV vaccination uptake (≥1 dose) by age 16 years among women ranges from 31% to 80% across 26 cantons (states). Our objective was to identify factors that are associated with the spatial variation in HPV vaccination uptake. METHODS We used cross-sectional data from the Swiss National Vaccination Coverage Survey 2009-2016 on HPV vaccination status (≥1 dose) of 14-17-year-old girls, their municipality of residence and their nationality for 21 of 26 cantons (n=8965). We examined covariates at municipality level: language, degree of urbanisation, socioeconomic position, religious denomination, results of a vote about vaccination laws as a proxy for vaccine scepticism and, at cantonal level, availability of school-based vaccination and survey period. We used a series of conditional autoregressive models to assess the effects of covariates while accounting for variability between cantons and municipal-level spatial autocorrelation. RESULTS In the best-fit model, living in cantons that have school-based vaccination (adjusted OR 2.51; 95% credible interval 1.77 to 3.56) was associated with increased uptake, while living in municipalities with lower acceptance of vaccination laws was associated with lower HPV vaccination uptake (OR 0.61; 95% credible interval 0.50 to 0.73). Overall, the covariates explained 88% of the municipal-level variation in uptake. CONCLUSIONS In Switzerland, both cantons and community opinion about vaccination play a prominent role in the variation in HPV vaccination uptake. To increase uptake, efforts should be made to mitigate vaccination scepticism and to encourage school-based vaccination.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
03 Faculty of Business, Economics and Social Sciences > Social Sciences > Institute of Political Science
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)
Graduate School for Health Sciences (GHS)

UniBE Contributor:

Riesen, Maurane Vanessa Joëlle; Konstantinoudis, Garyfallos; Low, Nicola; Bühlmann, Marc; Spycher, Ben and Althaus, Christian

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services
300 Social sciences, sociology & anthropology > 320 Political science

ISSN:

2044-6055

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Tanya Karrer

Date Deposited:

24 May 2018 12:54

Last Modified:

27 Oct 2019 14:56

Publisher DOI:

10.1136/bmjopen-2017-021006

PubMed ID:

29773702

Additional Information:

Riesen and Konstantinoudis contributed equally to this work. Spycher and Althaus contributed equally to this work.

Uncontrolled Keywords:

geographical variation human papillomavirus inla spatial analysis vaccination vaccine scepticism

BORIS DOI:

10.7892/boris.116823

URI:

https://boris.unibe.ch/id/eprint/116823

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