# Clusters and their social determinants associated with vaccination against human papillomavirus in the state of Minas Gerais, Brazil

## TL;DR

This study explores how social factors and geographic clusters influence HPV vaccination rates among adolescents in Minas Gerais, Brazil.

## Contribution

The study introduces a clustering approach to identify geographic and socioeconomic patterns affecting HPV vaccine adherence in Brazil.

## Key findings

- Municipalities with high urbanization and better socioeconomic conditions showed higher vaccination coverage.
- Clusters with high poverty and limited health access had the lowest vaccination rates.
- Male adolescents showed lower vaccination adherence compared to females across most clusters.

## Abstract

To analyze the clusters and their social determinants associated with vaccination against human papillomavirus (HPV) in the State of Minas Gerais, Brazil.

Ecological study, carried out in 853 municipalities of Minas Gerais, Brazil. The K-means algorithm was used for clustering analysis. The calculation of vaccination coverage (VC) of the HPV vaccine, for males and females, age group 9 to 14 years, between 2014 and 2022, and socioeconomic indicators were considered.

Males had the lowest proportion of municipalities in Minas Gerais achieving the VC target. Of the 5 Clusters generated, Cluster 1 (259 municipalities) showed high urbanization and high VC, but with challenges for male adherence. Cluster 2 (178 municipalities) identified low VC and high poverty, with limited access to health. Cluster 3 (166 municipalities) presented high VC and lower vulnerability, consisting of municipalities with high vaccination uptake and socioeconomic conditions, indicating effective health policies. In Cluster 4 (166 municipalities), public health weaknesses and the need for targeted interventions were identified. Cluster 5 (84 municipalities) presented high urbanization and inequality, but with a large disparity between urbanization and vaccination adherence.

Thus, this study identified that high urbanization, lower vulnerability and greater access to health services are factors that can positively impact vaccine adherence by adolescents.

Analisar os clusters e seus determinantes sociais associados à vacinação contra o papilomavírus humano (HPV) no estado de Minas Gerais, Brasil.

Estudo ecológico, realizado nos 853 municípios de Minas Gerais, Brasil. O algoritmo K-means foi utilizado para a análise dos clustering. Considerou-se o cálculo da cobertura vacinal (CV) da vacina HPV, para o público masculino e feminino, faixa etária de nove a 14 anos, entre 2014 e 2022, e os indicadores socioeconômicos.

O sexo masculino apresentou a menor proporção de municípios de Minas Gerais com alcance de meta de CV. Dos cinco clusters gerados, o 1 (259 municípios) apresentou alta urbanização e CV alta, mas com desafios para a adesão masculina. O cluster 2 (178 municípios), identificou baixa CV e alta pobreza, com acesso limitado à saúde. O cluster 3 (166 municípios) apresentou alta CV e menor vulnerabilidade, sendo constituído por municípios com elevada adesão vacinal e condições socioeconômicas, indicando políticas de saúde efetivas. No cluster 4 (166 municípios), foram identificadas fragilidades em saúde pública e necessidade de intervenções direcionadas. O cluster 5 (84 municípios) apresentou alto urbanismo e desigualdade, mas com grande disparidade entre urbanização e adesão à vacinação.

Assim, este estudo identificou que alta urbanização, menor vulnerabilidade e maior acesso aos serviços de saúde são fatores que podem impactar positivamente a adesão à vacina pelos adolescentes.