Background: Since its introduction in 2007, French recommendations for Human papillomavirus (HPV) vaccination have been updated several times to broaden the target population and age range. Despite an increase since then, with less than 50% of girls vaccinated at age 15 in 2023, uptake of the vaccine has remained below the national target and the figures reported by other similar European countries.
Objectives: This study aimed to identify the characteristics associated with HPV vaccination among girls aged 10 to 14 in France and their evolution between 2007 and 2023.
Methods: Using comprehensive healthcare reimbursement data from the French National Health Data System (SNDS), all girls born between 1993 and 2013 were included and their status regarding HPV vaccination between 2007 and 2023 was assessed. A multivariable analysis was performed to identify factors associated with vaccination at both individual and ecological levels (municipality of residence). The models were adjusted for healthcare access, healthcare utilization, comorbidities, time period and geography.
Results: Among 8.6 million eligible girls, 2.7 million received an HPV vaccine. HPV vaccination was significantly less likely in the most socially deprived girls, i.e. those covered by the complementary solidarity health insurance (C2S) (adjusted OR (aOR): 0.65 [95%CI: 0.65 ; 0.65]), and those residing in cities with the highest quintiles of the deprivation index (aOR: 0.72 [0.71 ; 0.72]) or of immigrant population rate (aOR: 0.70 [0.69 ; 0.70]). These social disparities in vaccination uptake have worsened over time, as indicated by decreases in aOR associated with C2S (from 0.83 in 2007-2012 to 0.54 in 2021-2023), with high deprivation index (from 0.91 to 0.68) and with high immigrant population rate (from 0.73 to 0.64). Frequency of contacts with primary healthcare practitioners, having received another vaccine in the five years preceding the index date and comorbidities including diabetes, mental disorders and asthma were also associated with HPV vaccination.
Conclusions: Our findings show increasingly marked social disparities in HPV vaccination uptake in France. School-based vaccination, set up since 2023-2024, provides a more systematic approach to offering the vaccine to all eligible adolescents. It will be crucial to assess whether this initiative helps reduce social disparities and improve overall vaccination coverage.
