Structural Determinants of HPV Vaccination Inequalities: A Multiregional Analysis across Six WHO Regions

Cervical cancer remains one of the most prevalent malignancies affecting women globally, and HPV vaccination is widely recognized as the cornerstone of primary prevention. Drawing on global macro-level data from 2013 to 2018, this study systematically evaluated the spatiotemporal patterns of HPV vaccination coverage and its associations with multiple structural determinants. By integrating indicators including first- and final-dose vaccine coverage, cervical cancer mortality, per capita GDP, physician density, government health expenditure, women’s educational attainment, female social participation, labor force involvement, and the inclusion of HPV vaccines in national immunization programs (NIPs), and applying visualization, correlation analysis, and Slope Index of Inequality (SII) modeling, we revealed pronounced inequities in HPV vaccination across the globe. Through the integration of visualization, correlation analyses, and Slope Index of Inequality (SII) modeling, we uncovered marked inequities in HPV vaccination coverage across the globe. The findings demonstrate that structural health inequalities constitute a fundamental barrier to achieving equitable HPV vaccine uptake. Future strategies should emphasize multidimensional policy interventions, including prioritized fiscal investment, institutional design optimization, and gender equity promotion, to enhance resource allocation efficiency and improve access to women’s health services. These measures will provide robust scientific evidence and policy guidance for advancing the global cervical cancer elimination agenda.