Risk of disease and willingness to vaccinate in the United States: A population-based survey.
Risk of disease and willingness to vaccinate in the United States: A population-based survey.
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疾病的风险和在美国接种疫苗的意愿：一项基于人群的调查。
DOI：
10.1371/journal.pmed.1003354
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发表时间：
2020-10
期刊：
影响因子：
15.8
通讯作者：
Miller CR
中科院分区：
文献类型：
--
作者：
Baumgaertner B;Ridenhour BJ;Justwan F;Carlisle JE;Miller CR
当人们认为疫苗可预防疾病的风险足够低，不再认为疫苗接种是一种必要的预防措施时，就会出现疫苗接种自满情绪。疾病暴发可能再次增加对风险的认识，从而减少对疫苗的自满情绪，进而减少对疫苗的犹豫。然而，人们对感知风险的变化如何转化为疫苗犹豫的变化还不是很清楚。我们提出了疫苗倾向的概念，它将疫苗接种意愿的变化与感知感染风险的变化联系起来，固定了其他考虑因素，如疫苗信心和便利性。我们使用了一种原始的调查工具，该工具呈现了7种疫苗可预防的“新”疾病，以收集2018年美国人口统计学上多样化的样本数据（N = 2411）。我们的调查于2018年1月25日至2018年2月2日在网上进行，分为三个部分。首先，我们收集了参与者在一个典型的一周内居住和访问的地方的信息。其次，研究人员向参与者展示了7种假设疾病爆发中的一种，并询问他们将如何应对。第三，收集社会人口统计信息。该调查的目的是在5个主要方面匹配美国的人口参数：年龄、性别、收入、种族和人口普查地区。我们还能够密切配合教育。研究参与者的总体人口统计细节为平均年龄43.80岁，47%为男性，53%为女性，38.5%为大学学历，24%为非白人。我们发现，随着感染风险的增加，愿意接种疫苗的比例至少发生了30%的总体变化。在考虑发病率信息的情况下，愿意接种疫苗的比例从0例当地病例时的0.476（0.449 ~ 0.503）上升到100例当地病例时的0.871(0.852 ~ 0.888)（上下95%置信区间）。考虑死亡信息时，该比例从0例当地病例时的0.526（0.494-0.557）上升到100例当地病例时的0.916（0.897-0.931）。此外，我们发现死亡率的风险比单纯的发病率引起更大的比例愿意接种疫苗（P = 0.0002），老年人比年轻人更愿意（P<0.0001），最高收入阶层（bb0 $90,000）比其他所有人更愿意（P = 0.0001），男性比女性更愿意（P = 0.0011），并且愿意接种疫苗的比例与意识形态和风险水平有关（P = 0.004）。本研究的局限性包括，它没有考虑其他因素（如社会影响）如何在人们的疫苗决策中与当地病例数相互作用，它无法确定发病率或死亡率的不同严重程度是否因为调查设计或参与者使用启发式驱动的决策而没有统计显着性，并且该研究没有捕捉到未在线的美国部分。在本研究中，我们发现不同程度的风险（就当地病例而言）对应于不同比例的人群愿意接种疫苗。我们还确定了疫苗倾向的几个社会人口学方面。了解疫苗倾向如何受到社会人口因素的影响，对于预测更有可能发生疫情的地方及其预期规模是非常宝贵的，即使疫苗接种率和对潜在疫情的相应反馈会随之发生变化。在一项基于人群的调查中，Bert Baumgaertner及其同事调查了与美国成年人接种疫苗意愿相关的因素，以预防一种假设的疫苗可预防疾病。在美国，疫苗可预防的疾病有所下降（~1970 - 2000年），随后是疫苗犹豫率上升（~ 2000-2018年）。在发生疾病暴发的地方，疫苗接种率已经回升（~ 2000-2018年）。我们进行这项调查是为了更好地了解当地病例如何影响人们接种疫苗。我们进行了一项调查，向参与者展示了7种新疾病爆发中的一种，每种疾病都有不同程度的发病率或死亡率。我们询问参与者需要多少当地病例计数才能接种该疾病的疫苗。与发病率风险相比，在病例数较少的情况下，死亡率风险与更大的接种意愿相关。同样，老年人比年轻人更愿意接种疫苗，高收入人群比所有收入水平的人更愿意接种疫苗，男性比女性更愿意接种疫苗，我们的研究结果表明，接种疫苗的意愿与政治意识形态之间存在关系。人们决定接种疫苗的部分原因是他们是否有感染这种疾病的风险，这种评估在不同人群中可能有所不同。这些信息有助于旨在减少疫苗犹豫的运动，并有助于建立人类决策与疾病传播之间的反馈模型。
Vaccination complacency occurs when perceived risks of vaccine-preventable diseases are sufficiently low so that vaccination is no longer perceived as a necessary precaution. Disease outbreaks can once again increase perceptions of risk, thereby decrease vaccine complacency, and in turn decrease vaccine hesitancy. It is not well understood, however, how change in perceived risk translates into change in vaccine hesitancy. We advance the concept of vaccine propensity, which relates a change in willingness to vaccinate with a change in perceived risk of infection—holding fixed other considerations such as vaccine confidence and convenience. We used an original survey instrument that presents 7 vaccine-preventable “new” diseases to gather demographically diverse sample data from the United States in 2018 (N = 2,411). Our survey was conducted online between January 25, 2018, and February 2, 2018, and was structured in 3 parts. First, we collected information concerning the places participants live and visit in a typical week. Second, participants were presented with one of 7 hypothetical disease outbreaks and asked how they would respond. Third, we collected sociodemographic information. The survey was designed to match population parameters in the US on 5 major dimensions: age, sex, income, race, and census region. We also were able to closely match education. The aggregate demographic details for study participants were a mean age of 43.80 years, 47% male and 53% female, 38.5% with a college degree, and 24% nonwhite. We found an overall change of at least 30% in proportion willing to vaccinate as risk of infection increases. When considering morbidity information, the proportion willing to vaccinate went from 0.476 (0.449–0.503) at 0 local cases of disease to 0.871 (0.852–0.888) at 100 local cases (upper and lower 95% confidence intervals). When considering mortality information, the proportion went from 0.526 (0.494–0.557) at 0 local cases of disease to 0.916 (0.897–0.931) at 100 local cases. In addition, we ffound that the risk of mortality invokes a larger proportion willing to vaccinate than mere morbidity (P = 0.0002), that older populations are more willing than younger (P<0.0001), that the highest income bracket (>$90,000) is more willing than all others (P = 0.0001), that men are more willing than women (P = 0.0011), and that the proportion willing to vaccinate is related to both ideology and the level of risk (P = 0.004). Limitations of this study include that it does not consider how other factors (such as social influence) interact with local case counts in people’s vaccine decision-making, it cannot determine whether different degrees of severity in morbidity or mortality failed to be statistically significant because of survey design or because participants use heuristically driven decision-making that glosses over degrees, and the study does not capture the part of the US that is not online. In this study, we found that different degrees of risk (in terms of local cases of disease) correspond with different proportions of populations willing to vaccinate. We also identified several sociodemographic aspects of vaccine propensity. Understanding how vaccine propensity is affected by sociodemographic factors is invaluable for predicting where outbreaks are more likely to occur and their expected size, even with the resulting cascade of changing vaccination rates and the respective feedback on potential outbreaks. In a population-based survey, Bert Baumgaertner and colleagues investigate factors associated with willingness of US adults to vaccinate for a hypothetical vaccine-preventable disease. In the US, vaccine-preventable diseases have gone down (~1970–2000s), followed by a rise in vaccine hesitancy (~2000–2018). In places where disease outbreaks have occurred, vaccination rates have gone back up (~2000–2018). We conducted this survey to better understand how local cases of disease can influence people to vaccinate. We conducted a survey that presented participants with one of 7 new disease outbreaks, each with a different degree of morbidity or mortality. We asked participants how many local case counts it would take for them to vaccinate against that disease. The risk of mortality was associated with greater willingness to vaccinate in the presence of fewer case counts compared to the risk of morbidity. Likewise, older populations were more willing than younger, people with high incomes were more willing than all income levels, men were more willing than women, and our findings suggest a relationship between willingness to vaccinate and political ideology. Part of people’s decision to vaccinate is their risk of contracting the disease, and this assessment can vary across different populations. This information can be helpful for campaigns that aim to reduce vaccine hesitancy and is useful for modeling feedback between human decision-making and the spread of disease.
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DOI：
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The Lancet. Infectious diseases
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