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General Practitioner Attendance in Proximity to HPV Vaccination: A Nationwide, Register-Based, Matched Case–Control Study

Authors Lützen TH, Rask CU, Plana-Ripoll O, Bech BH, Krogsgaard LW, Rolving N, Rytter D

Received 8 May 2020

Accepted for publication 15 July 2020

Published 8 September 2020 Volume 2020:12 Pages 929—939


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Irene Petersen

Tina Hovgaard Lützen,1 Charlotte Ulrikka Rask,2,3 Oleguer Plana-Ripoll,4 Bodil Hammer Bech,1 Lene Wulff Krogsgaard,1 Nanna Rolving,5,6 Dorte Rytter1

1Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus C 8000, Denmark; 2Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus N 8200, Denmark; 3Department of Clinical Medicine, Aarhus University, Aarhus N 8200, Denmark; 4National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus V 8210, Denmark; 5University Clinic of Innovative Patient Pathways, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg 8600, Denmark; 6DEFACTUM, Corporate Quality, Central Denmark Region, Aarhus N 8200, Denmark

Correspondence: Tina Hovgaard Lützen Research Unit for Epidemiology, Department of Public Health
Aarhus University, Bartholins Allé 2, Aarhus C 8000, Denmark
Tel +45 22410722

Aim: This study aimed to describe and compare general practitioner (GP) attendance patterns in the years surrounding HPV-vaccination among cases suspected to experience adverse events and their matched controls in order to determine if a potential larger change in GP attendance among cases was observed in temporal relation to vaccination.
Methods: Register-based, matched case–control study. Cases were defined as women referred to specialized hospital settings (HPV-centers) for suspected adverse event between June 1st 2015 and December 31st 2015 (n=1458). Information on referral was obtained from the HPV-centers directly. Each case was matched with five controls on age at vaccination, region, time of first vaccine registration and total number of doses, resulting in a total study population of 8670 girls and women. Negative binomial regression analyses were used (i) to estimate mean yearly GP contacts among cases and controls, and (ii) to further investigate the relative difference in change in GP attendance following vaccination between cases and controls.
Results: Overall, cases displayed higher GP attendance than controls from five years before vaccination up until five years after. Compared to controls, cases increased their GP attendance more in the years following HPV vaccination, corresponding to a 40% increase in the incidence rate ratios (IRR) from before to after vaccination (ratio-IRR = 1.40 [1.36; 1.44]). The change occurred in close proximity to vaccination, and the pattern was the same independently of the year of vaccination. However, for the later vaccination years cases displayed an additional increase in their GP attendance around time of extensive media attention.
Conclusion: Girls and women being referred for suspected adverse events after HPV-vaccination changed their GP attendance pattern in close proximity to their first HPV-vaccination and not solely in temporal linkage to the onset of public debate.

Keywords: HPV vaccination, general practice attendance, adverse effects, case–control

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