背景:尽管在宫颈癌筛查和发病率方面与精神疾病相关的差异有记载,关于宫颈癌预防策略差异的数据不足,例如人乳头瘤病毒(HPV)疫苗接种。我们旨在调查瑞典女孩及其父母的精神疾病和神经发育状况与HPV疫苗接种的关系。
方法:这项基于人群的队列研究基于瑞典学校的HPV疫苗接种计划,它为10-13岁的女孩提供第一剂疫苗,在12个月内提供第二剂。我们使用瑞典总人口登记册确定了2002年1月1日至2004年3月1日之间出生的所有女孩,从2012年秋季开始到3月,有资格在疫苗接种计划中接种两剂疫苗的人,2019.瑞典全国登记数据(国家患者登记,规定的药物登记册,HPV疫苗接种登记册,国家疫苗接种登记册,总人口登记,多代寄存器,健康保险和劳动力市场研究纵向综合数据库,教育登记册,全国子宫颈筛查登记处,和癌症登记册)用于定义个人和父母的心理健康状况,包括精神疾病和神经发育状况(由临床诊断和处方精神药物使用定义),HPV疫苗摄取(第一和第二剂),以及社会人口统计学和临床特征。这两个结果是在女孩14岁生日时摄取第一剂HPV疫苗,在15岁生日时摄取第二剂HPV疫苗,与个人和父母的心理健康状况有关。使用多变量泊松回归模型计算。
结果:115104名女孩被纳入研究人群。2211名女孩(1·9%)有任何精神健康状况的专家诊断。第一次接种HPV疫苗的比例为80·7%(9912/115104),与没有任何心理健康状况的女孩相比,其比例较低(调整后相对风险0·89[95%CI0·87-0·91])。自闭症(0·79[0·75-0·85])或智力残疾(0·78[0·73-0·83])的诊断与较低的HPV疫苗摄取率密切相关。与未使用精神药物的女孩相比,接种疫苗的女孩也较低(0·93[0·92-0·95]),与抗精神病药最强的相关性(0·68[0·56-0·82])。第二次剂量的摄取为95·0%(88308/92912),女孩或其父母的摄取与心理健康状况之间没有很强的联系。
结论:我们的研究结果表明,有心理健康状况的女孩在宫颈癌预防方面存在差异,并呼吁进一步研究以确保公平保护。
背景:瑞典癌症协会。
BACKGROUND: Despite documented mental illness-related disparities in cervical cancer screening and incidence, insufficient data exist on differences in cervical cancer prevention strategies, such as human papillomavirus (HPV) vaccination. We aimed to investigate the association of mental illness and neurodevelopmental conditions among girls and their parents with uptake of HPV vaccination in Sweden.
METHODS: This population-based cohort study was based on the Swedish school-based HPV vaccination programme, which offers the first vaccine dose to girls aged 10-13 years, with a second dose offered within 12 months. We identified all girls born between Jan 1, 2002, and March 1, 2004, using the Swedish Total Population Register-ie, those eligible for two vaccine doses in the vaccination programme from its initiation in autumn 2012, to March, 2019. Nationwide Swedish register data (National Patient Register, Prescribed Drug Register, HPV Vaccination Register, National Vaccination Register, Total Population Register, Multi-Generation Register, Longitudinal Integrated Database for Health Insurance and Labour Market Studies, Education Register, National Cervical Screening Registry, and Cancer Register) were used to define individual and parental mental health conditions, including mental illness and neurodevelopmental conditions (defined by a clinical diagnosis and prescribed psychotropic medication use), HPV vaccine uptake (first and second dose), and sociodemographic and clinical characteristics. The two outcomes were uptake of the first HPV vaccine dose by the girl\'s 14th birthday and uptake of the second dose by the 15th birthday in relation to individual and parental mental health conditions, calculated using multivariable Poisson regression models.
RESULTS: 115 104 girls were included in the study population. 2211 girls (1·9%) had a specialist diagnosis of any mental health condition. Uptake of the first HPV vaccine dose was 80·7% (92 912 of 115 104) and was lower among girls with versus without any mental health condition (adjusted relative risk 0·89 [95% CI 0·87-0·91]). The diagnosis of autism (0·79 [0·75-0·85]) or intellectual disability (0·78 [0·73-0·83]) were most strongly associated with lower HPV vaccine uptake. Vaccine uptake was also lower among girls with versus those without prescribed use of psychotropic medication (0·93 [0·92-0·95]), with the strongest association observed for antipsychotics (0·68 [0·56-0·82]). Uptake of the second dose was 95·0% (88 308 of 92 912), with no strong associations between uptake and mental health conditions in girls or their parents.
CONCLUSIONS: Our findings suggest disparities in cervical cancer prevention among girls with mental health conditions, and call for further research to ensure equitable protection.
BACKGROUND: Swedish Cancer Society.