The study team examined population-level HPV vaccination uptake in the Campania Region from 2006 through 2023, using birth cohorts born 1997–2011. Coverage did not reach recommended targets for either sex across the observation window. Female cohort peaks were higher than male peaks; the single highest reported one-dose female coverage reached 68.5% for the 2005 cohort, while male one-dose peaked at 41.1% for the 2007 cohort. Full immunisation reached 62.2% in a female cohort (2002) versus 29.9% in the best-performing male cohort (2007). Catch-up uptake remained minimal for both sexes, with the highest female catch-up at 2.2% (1998 cohort) and the highest male catch-up at 0.6% (1999–2002 cohorts).
These raw cohort figures come from linked immunisation-registry records aggregated at the Health District (HD) level. The authors reported cohort-specific peaks and troughs in coverage rather than universal attainment of coverage goals.
Investigators linked vaccination records to the 2011 Deprivation Index (DI) to evaluate socio-economic gradients. The mixed-effects regression analyses showed higher deprivation correlated with lower male one-dose coverage and lower male full-immunisation coverage; reported coefficients were -1.56 (95% CI -2.83 to -0.29) and -1.36 (95% CI -2.35 to -0.37), respectively. In females, routine coverage did not show a significant association with deprivation according to the abstract, but catch-up pathways were negatively associated with deprivation (coefficient -0.057, 95% CI -0.094 to -0.020).
The pattern the authors reported suggests that socio-economic inequalities differentially affect uptake by sex and by vaccination pathway: male routine and full courses decline with greater deprivation, while female routine programmes appear resilient but female catch-up is sensitive to socio-economic status. The authors framed these findings in terms of programme equity, noting that a universal, actively offered programme may have protected routine female uptake from the same deprivation effects seen elsewhere.
Coverage varied across Local Health Authorities (LHAs) and Health Districts (HDs). The investigators adjusted for vaccination-centre density in their aggregated analyses and still observed geographic variability in uptake. The abstract states that this heterogeneity was independent of the measured vaccination-centre density, implying other local organisational, cultural, or access factors drove between-area differences in coverage.
The models incorporated HDs nested within LHAs as random intercepts, which captured clustering of coverage values by administrative units and allowed the authors to quantify residual territorial heterogeneity after accounting for measured covariates.
The study used population registries of immunisation linked with demographic data and the 2011 Deprivation Index, aggregated at HD level. The birth cohorts analysed spanned 1997–2011 and the study observation period was 2006–2023. Outcomes assessed were threefold: one-dose coverage, full-immunisation coverage, and catch-up coverage defined as at least one dose after age 18. The statistical approach consisted of mixed-effects linear regression with HDs nested in LHAs as random intercepts. The abstract reports coefficients and confidence intervals for key associations between deprivation and coverage for specified sex-specific outcomes.
The abstract did not provide additional details on variable definitions beyond those outcomes, nor did it list adjustment covariates other than vaccination-centre density; full-text inspection would be required to review variable operationalisation, model covariates, and sensitivity analyses.
Key numeric results reported in the abstract: female one-dose peak 68.5% (2005 cohort); female full-immunisation peak 62.2% (2002 cohort); female catch-up peak 2.2% (1998 cohort). Male one-dose peak 41.1% (2007 cohort); male full-immunisation peak 29.9% (2007 cohort); male catch-up highest reported 0.6% (1999–2002 cohorts). Regression coefficients linking higher deprivation to lower male coverage were -1.56 (95% CI -2.83 to -0.29) for one dose and -1.36 (95% CI -2.35 to -0.37) for full immunisation. Female catch-up was negatively associated with deprivation (coeff -0.057; 95% CI -0.094 to -0.020).
These figures derive from registry linkage and aggregate HD-level analysis as described in the abstract. The authors used mixed-effects modelling to account for clustering by administrative unit.
The abstract did not list explicit study limitations, did not report sample sizes per cohort or per HD, and did not provide details on other model covariates or sensitivity checks. It also did not describe specific local organisational practices or interventions that might explain the observed territorial heterogeneity. For operational details—such as the exact DI construction, definitions used for full immunisation across different vaccine schedules, denominators by cohort, or any temporal trends in service delivery—the full text would need to be consulted.
Unanswered clinical and public-health questions that remain from the abstract include which local organisational factors (beyond vaccination-centre density) most strongly drive the geographic differences, and which targeted strategies could mitigate the observed socio-economic gaps in male and catch-up uptake. The authors concluded that territorial heterogeneity and socio-economic inequalities shape HPV vaccination uptake in Campania, and they argued that universal, actively offered programmes may protect routine female coverage; the abstract points readers to the full article for detailed methods and further contextual interpretation.