关键词: 乳头状瘤病毒疫苗, 疫苗接种覆盖率, 地理加权回归模型, 社会经济因素, 影响因素分析

Abstract: Background Cervical cancer is the fourth most common malignant tumor among women worldwide, with persistent infection of high-risk human papillomavirus (HR-HPV) being its necessary cause. HPV vaccination can effectively prevent cervical cancer; however, the coverage rate of HPV vaccination in China remains far below the 90% target set by the WHO. Current research on factors influencing HPV vaccine coverage is insufficient. This study aims to contribute evidence to this field. Objective To explore the spatial relationships between HPV vaccine coverage and its influencing factors among the eligible population in China, and to provide a scientific basis for formulating region-specific HPV vaccination strategies tailored to the actual conditions of different provincial-level administrative regions. Methods The dependent variable was derived from the 2022 regional statistics on HPV vaccine coverage released by the Chinese Center for Disease Control and Prevention. Independent variables were obtained from the Seventh National Population Census, the China Statistical Yearbook 2022, and the National Bureau of Statistics, covering 10 continuous variables across two categories: socioeconomic level and health indicators. These included female junior high school, senior high school, and higher education rates; female illiteracy rate; female employment rate; proportion of ethnic minority women; proportion of rural women; per capita disposable income; per capita healthcare expenditure; and number of community health service centers (stations). All variables were included in the model in their original form. Data processing and general analysis were performed using R software, and a linear regression model was constructed. Global spatial autocorrelation analysis, geographically weighted regression (GWR) modeling, and hotspot analysis were conducted using ArcGIS software, with spatial distribution maps generated. Data collection and analysis were completed in April 2025. Results The HPV vaccine coverage rates across provinces ranged from 2.55% to 25.4%. Significant differences in coverage were observed among provincial-level administrative regions, exhibiting distinct spatial clustering characteristics (Moran's I index=0.198, P=0.007). Coverage was higher in southeastern regions and the Sichuan-Chongqing area, while relatively lower in western regions. HPV vaccine coverage was influenced by female education level, economic status, female sociodemographic characteristics, and the number of community health service centers (stations) (P<0.05), with varying degrees of impact across spaces. Conclusion HPV vaccine coverage in China demonstrates a pattern of higher rates in the southeast and lower rates in the northwest. Female higher education rate, per capita disposable income, and proportion of rural women are core factors contributing to this spatial disparity. A triple policy of "central government full funding, mobile vaccination units, and health education campaigns" could be implemented in western regions. Eastern regions should provide economic support for disadvantaged populations. Central regions could expand the eligibility for HPV vaccination subsidies and convert high health literacy into higher vaccination rates through behavioral incentives. Adopting precise, localized strategies will enhance HPV vaccine coverage and substantially advance the elimination of cervical cancer.

Key words: Papillomavirus vaccines, Vaccination coverage, Geographically weighted regression model, Socioeconomic factors, Root cause analysis