TY - JOUR

T1 - Human papillomavirus immunization uptake among girls with a refugee background compared with Danish-born girls

T2 - a national register-based cohort study

AU - P. Møller, Sanne

AU - Kristiansen, Maria

AU - Norredam, Marie

PY - 2018/1

Y1 - 2018/1

N2 - 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.

AB - 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.

KW - Adolescent

KW - Child

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Health Services Accessibility

KW - Humans

KW - Papillomavirus Infections/prevention & control

KW - Papillomavirus Vaccines/administration & dosage

KW - Patient Acceptance of Health Care/statistics & numerical data

KW - Refugees/statistics & numerical data

KW - Registries/statistics & numerical data

KW - Vaccination/statistics & numerical data

KW - access

KW - human papilloma virus

KW - children

KW - immunizations

KW - refugee

KW - migration

KW - child healthcare

KW - register-based

UR - http://www.scopus.com/inward/record.url?scp=84974851197&partnerID=8YFLogxK

U2 - 10.1097/CEJ.0000000000000274

DO - 10.1097/CEJ.0000000000000274

M3 - Journal article

C2 - 27307374

VL - 27

SP - 42

EP - 45

JO - European Journal of Cancer Prevention

JF - European Journal of Cancer Prevention

SN - 0959-8278

IS - 1

ER -