Social Deprivation and HPV Screening uptake: A Spatial Analysis in Rome’s Largest Local Health Unit

Abstract Background Human papillomavirus (HPV) is the most common sexually transmitted infection globally, with high-risk types linked to various cancers, particularly cervical cancer - the fourth leading cause of death among women worldwide. Despite effective prevention strategies, socioeconomic factors influence screening uptake even in high-income nations. This study assesses the association between deprivation level and HPV screening uptake in ASL Roma 2, the largest Local Health Unit in Lazio region. Methods This cross-sectional study included women aged 25-64 years eligible for organized cervical cancer screening. Cases were defined as women undergoing screening. Screening uptake was calculated as participants completing screening divided by total eligible individuals. Descriptive analysis characterized the population. Chi-square tests, t-tests, and multivariate logistic regression evaluated association between deprivation levels and participation. Spatial autocorrelation analysis was adopted to identify clustering patterns. Results Among 26,820 eligible women, overall uptake was 27.5%, with substantial variation between low and high deprivation areas (37.2% vs 19.8%, p < 0.001). Multivariate logistic regression showed women in high deprivation areas had 2.3 times lower odds of participating (OR 2.3, 95% CI 1.97-3.48) compared to low deprivation areas, after adjusting for age and education. Spatial analysis identified significant clustering of low participation in southeastern districts (Moran's I = 0.42, p < 0.001), coinciding with higher deprivation scores. Conclusions The significant association between deprivation and lower screening uptake necessitates targeted interventions. Health planners should prioritize resources for low-participation clusters through neighborhood-based outreach programs and mobile screening units. These findings underscore the importance of equity-focused approaches in program design to reduce preventable cervical cancer mortality. Key messages • Significant disparities in HPV screening uptake exist across socioeconomic groups, with women in high deprivation areas having lower participation rates despite organized screening programs. • Targeted, equity-focused interventions in identified low-participation clusters are essential to reduce preventable cervical cancer mortality and address socioeconomic barriers to screening.