Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007-2008.
Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007-2008.
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DOI：
10.1136/jech-2011-200341
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发表时间：
2012-10
影响因子：
6.3
通讯作者：
Vaccine Coverage Survey 2007 Group
中科院分区：
文献类型：
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作者：
Barata RB;Ribeiro MC;de Moraes JC;Flannery B;Vaccine Coverage Survey 2007 Group
自 1988 年以来，巴西的统一卫生系统一直致力于提供普遍且平等的免疫接种机会。免疫接种的不平等可以通过对比最高社会经济阶层和最低社会经济阶层儿童的疫苗接种覆盖率来检查。作者根据居住人口普查区的社会经济阶层对巴西儿童进行了调查，研究了常规婴儿免疫接种的覆盖率。作者根据平均家庭收入和户主教育程度，在巴西 26 个首都和联邦区的五个社会经济阶层中系统地选择了人口普查区，进行了家庭聚类调查。作者根据居住人口普查区的社会经济五分位数计算了 18 个月大之前儿童的推荐疫苗接种覆盖率，并检查了与疫苗接种不完全相关的因素。在 17 295 名持有免疫卡的儿童中，14 538 名（82.6%）在 18 个月大时已接受了所有推荐的疫苗接种。在居住在社会经济最高阶层的人口普查区的儿童中，77.2% 的儿童在 18 个月大时已完全免疫，而居住在社会经济指标较低的四个人口普查区五分位数的儿童中，这一比例为 81.2%–86.2%（p<0.01）。社会经济指标最高的五分位人口普查区的卡介苗、口服脊髓灰质炎疫苗和乙型肝炎疫苗的覆盖率明显低于社会经济指标较低的人口普查区。在多变量分析中，较高的出生顺序和居住在社会经济地位最高的五分之一与不完整的疫苗接种有关。在调整了户口普查区社会经济阶层与家庭财富指数之间的相互作用后，只有出生顺序仍然显着。来自巴西首都的证据表明，贫困儿童在实现高免疫覆盖率方面取得了成功。需要制定策略来惠及富裕地区的儿童。
Since 1988, Brazil's Unified Health System has sought to provide universal and equal access to immunisations. Inequalities in immunisation may be examined by contrasting vaccination coverage among children in the highest versus the lowest socioeconomic strata. The authors examined coverage with routine infant immunisations from a survey of Brazilian children according to socioeconomic stratum of residence census tract. The authors conducted a household cluster survey in census tracts systematically selected from five socioeconomic strata, according to average household income and head of household education, in 26 Brazilian capitals and the federal district. The authors calculated coverage with recommended vaccinations among children until 18 months of age, according to socioeconomic quintile of residence census tract, and examined factors associated with incomplete vaccination. Among 17 295 children with immunisation cards, 14 538 (82.6%) had received all recommended vaccinations by 18 months of age. Among children residing in census tracts in the highest socioeconomic stratum, 77.2% were completely immunised by 18 months of age versus 81.2%–86.2% of children residing in the four census tract quintiles with lower socioeconomic indicators (p<0.01). Census tracts in the highest socioeconomic quintile had significantly lower coverage for bacille Calmette-Guérin, oral polio and hepatitis B vaccines than those with lower socioeconomic indicators. In multivariable analysis, higher birth order and residing in the highest socioeconomic quintile were associated with incomplete vaccination. After adjusting for interaction between socioeconomic strata of residence census tract and household wealth index, only birth order remained significant. Evidence from Brazilian capitals shows success in achieving high immunisation coverage among poorer children. Strategies are needed to reach children in wealthier areas.
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