Human papillomavirus vaccine uptake among individuals with systemic inflammatory diseases.
Human papillomavirus vaccine uptake among individuals with systemic inflammatory diseases.
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DOI：
10.1371/journal.pone.0117620
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Kim SC
中科院分区：
文献类型：
--
作者：
Feldman CH;Hiraki LT;Lii H;Seeger JD;Kim SC
人乳头瘤病毒（HPV）疫苗对持续性HPV感染率较高的全身性炎症性疾病（SID）患者安全有效。我们比较了SID和非SID患者的HPV疫苗接种率。使用美国保险索赔数据库（2006 - 2012年），我们确定了9 - 26岁的个体，其中≥ 2个SID诊断代码间隔≥ 7天，在第二个代码（索引日期）之前连续入组≥ 12个月。我们根据年龄、性别和索引日期将SID患者与随机选择的非SID受试者进行匹配，并选择索引日期后连续随访≥ 24个月的受试者。我们还确定了一个非SID子队列，其中有≥ 1个哮喘诊断代码。我们将启动定义为2007年后≥ 1次HPV疫苗接种要求，完成定义为3次接种要求。我们使用多变量逻辑回归来评估11 - 26岁女性的吸收，比较SID、非SID和哮喘队列，调整人口统计学、地区、合并症和医疗保健利用。我们确定了5，642名9 - 26岁的SID患者和20，643名无SID患者。平均年龄为18.1岁（SD 4.9）。我们确定了1,083例哮喘患者;平均年龄为17.2岁（SD 5.1）。在女性中，20.6%的SID、23.1%的无SID和22.9%的哮喘患者接受了≥ 1次HPV疫苗接种。在我们调整后的模型中，与非SID组相比，SID组接受≥ 1种疫苗的几率低0.87倍（95% CI 0.77 - 0.98），3种疫苗无差异（OR 1.03，95% CI 0.83 - 1.26）。在SID和非SID哮喘队列之间，开始和完成的几率没有统计学差异。在这个全国性的队列中，HPV疫苗的接种率极低。尽管SID患者持续HPV感染的风险增加，但未观察到HPV疫苗摄取增加。公共卫生工作，以促进HPV疫苗接种的整体是必要的，并可能是特别有益的那些在较高的风险。
The human papillomavirus (HPV) vaccine is safe and efficacious in patients with systemic inflammatory diseases (SID) who have higher rates of persistent HPV infection. We compared HPV vaccine uptake among SID and non-SID patients. Using a U.S. insurance claims database (2006–2012), we identified individuals 9–26 years with ≥2 SID diagnosis codes ≥7 days apart with ≥12 months of continuous enrollment prior to the second code (index date). We matched SID patients by age, sex and index date to randomly selected non-SID subjects and selected those with ≥24 months of post-index date continuous follow-up. We also identified a non-SID subcohort with ≥1 diagnosis code for asthma. We defined initiation as ≥1 HPV vaccination claim after 2007, and completion as 3 claims. We used multivariable logistic regression to assess uptake in females 11–26 years comparing SID, non-SID and asthma cohorts, adjusting for demographics, region, comorbidities, and healthcare utilization. We identified 5,642 patients 9–26 years with SID and 20,643 without. The mean age was 18.1 years (SD 4.9). We identified 1,083 patients with asthma; the mean age was 17.2 (SD 5.1). Among females, 20.6% with SID, 23.1% without SID and 22.9% with asthma, received ≥1 HPV vaccine. In our adjusted models, the odds of receipt of ≥1 vaccine was 0.87 times lower in SID (95% CI 0.77–0.98) compared to non-SID and did not differ for 3 vaccines (OR 1.03, 95% CI 0.83–1.26). The odds of initiation and completion were not statistically different between SID and non-SID asthma cohorts. In this nationwide cohort, HPV vaccine uptake was extremely low. Despite the heightened risk of persistent HPV infection among those with SID, no increase in HPV vaccine uptake was observed. Public health efforts to promote HPV vaccination overall are needed, and may be particularly beneficial for those at higher risk.
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