Background HPV vaccination (HPVv) was introduced in the UK in 2008; currently 87%–93% of teenage girls receive at least one dose in school. Uptake is lower in more deprived areas, and, small regional studies report, among Black and minority ethnic groups. Associations with parental and household factors, and school attendance are less clear. Using data from a UK prospective cohort we tested the hypothesis that HPVv initiation is lower among those with parents from Black and minority ethnic groups, living in low income households, and not attending school.

Methods We estimated the percentage of 5690 14 year-old girls participating in the Millennium Cohort Study whose parent reported HPVv initiation. We used logistic regression to calculate crude and adjusted odds ratios (OR) of HPVv initiation and examined associations with parental ethnic group (baseline White), school type (non-fee-paying (baseline)/fee-paying/no school), history of school exclusion (baseline no exclusions), and household income (OECD quintile (baseline highest quintile)). Analyses were weighted for survey design (Stata: Release 15; StataCorp LP).

Results 5265 girls (weighted percentage: 92.3w%; 95% CI 91.3, 93.2) received at least one dose of HPVv; 399 (7.2w%; 6.4, 8.1) no doses; 26 (0.5w%; 0.3, 0.9) not known. Parents from Bangladeshi (86.1w%; 80.3, 90.4), Black African (84.9w%; 75.7, 91.0) and ‘other’ ethnic groups (81.0w%; 70.4, 88.4) were less likely to report HPVv initiation compared to those of White ethnicity (93.6w%; 92.5, 94.5). HPVv initiation was lower in girls not attending school (61.1w%; 32.5, 83.7) and those previously excluded from school (85.2w%; 78.9, 89.9). After adjusting for age, ethnicity, school type, exclusions and household income, girls with parents from Bangladeshi (OR: 0.57; 0.35, 0.93), Black African (OR: 0.43; 0.23, 0.80) or ‘other’ ethnic groups (OR: 0.30; 0.16, 0.58), those not attending school (OR: 0.11; 0.04, 0.34), with a history of school exclusion (OR: 0.48; 0.30, 0.78), or living in low income households (lowest two OECD quintiles OR: 0.46; 0.31, 0.67 and OR: 0.51; 0.34, 0.76), were less likely to initiate HPVv.

Conclusion In the UK, there are marked inequalities in HPVv initiation, with lower uptake among children from poorer households, with parents from Bangladeshi, Black African or other ethnic groups, and those previously excluded or not currently in school. This is the first report of HPVv initiation using a nationally representative cohort. Further work is needed to evaluate interventions for HPVv catch-up in the groups we have identified, who may also be at greater risk of missing cervical screening. Understanding reasons for non-initiation and developing interventions to engage parents from these groups is central to reducing inequalities in HPVv uptake.