Intersectional inequalities in HPV vaccination among female college students in China: a cross-sectional study

Abstract Background Human papillomavirus (HPV) vaccination is central to the World Health Organization strategy for cervical cancer elimination. China introduced free two-dose bivalent HPV vaccination for eligible 13-year-old girls in November 2025. We estimated inequalities in self-reported receipt of any HPV vaccine among female college students immediately before this national programme. Methods We analysed 44,052 female respondents from the 2025 National College Student Survey on Sexual and Reproductive Health (NCSS-SRH), a large weighted multi-institutional online survey conducted from April to September 2025 across all 31 mainland provincial-level administrative units. Modified Poisson models estimated adjusted prevalence ratios (aPRs), with standard errors clustered by current institution. Weighted logistic models provided covariate-standardized probabilities for 12 intersections of current college region, residence before college, and programme. Concentration indices quantified socioeconomic inequality. Results Overall weighted any-dose uptake was 18.4% (95% CI 16.4% to 20.5%). Uptake was 9.2% among rural-origin students, 9.9% among students at colleges in central China, 13.4% among junior college or vocational students, and 10.0% among ethnic minority students. In the fully adjusted model, uptake was associated with eastern versus central college location (aPR 1.80, 95% CI 1.49 to 2.17), western versus central location (aPR 1.67, 95% CI 1.32 to 2.10), urban versus county/town or rural origin (aPR 1.23, 95% CI 1.16 to 1.31), bachelor’s or postgraduate versus junior or vocational programme (aPR 1.21, 95% CI 1.06 to 1.39), and parental college education (aPR 2.04, 95% CI 1.87 to 2.22). Ethnic minority students had lower uptake than Han students (aPR 0.69, 95% CI 0.59 to 0.80). Observed intersectional uptake ranged from 5.8% to 37.0%; standardization narrowed this range to 9.2%–24.8% and changed several group ranks. Concentration indices were 0.26 (95% CI 0.21 to 0.30) for parental education and 0.18 (95% CI 0.15 to 0.22) for monthly expenditure. Conclusions Any-dose HPV vaccine uptake was socially patterned among female college students before national rollout. The estimates describe associations with current college setting and present circumstances. Equitable implementation requires accessible adolescent delivery, appropriate catch-up pathways for older cohorts, and monitoring that accounts for institutional context.