Statewide analysis of missed opportunities for human papillomavirus vaccination using vaccine registry data.
Statewide analysis of missed opportunities for human papillomavirus vaccination using vaccine registry data.
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DOI：
10.1016/j.pvr.2016.06.002
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发表时间：
2016-12
期刊：
影响因子：
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通讯作者：
Balch A
中科院分区：
文献类型：
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作者：
Kepka D;Spigarelli MG;Warner EL;Yoneoka Y;McConnell N;Balch A
人乳头瘤病毒（HPV）疫苗三剂完成率在美国的青少年女性是低的。错失的机会阻碍了HPV疫苗接种的覆盖率。对来自犹他州全州免疫信息系统（USIIS）的去识别疫苗接种和人口统计数据进行了基于人群的二次数据分析。记录包括2008-2012年期间任何时间25,866名11-26岁的女性，她们至少接受了usis记录的以下一种青少年疫苗接种：Tdap（破伤风、白喉、百日咳）、脑膜炎球菌和/或流感。错过HPV疫苗接种的机会被定义为患者至少接受了一次青少年疫苗接种，但没有接种HPV疫苗的临床遭遇。在47,665次符合条件的访问中，有20,911次错过了机会（43.87%）。年龄组、种族/民族和农村与错失机会显著相关（p<0.0001）。在包括种族、地点和年龄在内的多变量混合效应逻辑回归模型中，作为固定效应，受试者作为随机效应，西班牙裔人比白人更不可能错过机会，OR 0.59 (95% CI: 0.52-0.66)，小农村比城市青年更可能错过机会，OR 1.8 (95% CI: 1.5-2.2)，青春期前比青少年更可能错过机会，OR 2.4 （95% CI: 2.2-2.7）。错过临床机会是女性青少年接种HPV疫苗的重大障碍。需要针对那些为错失机会最多的患者群体提供服务的提供者采取干预措施，以实现对hpv相关疾病的充分保护。这是第一个利用国家免疫信息系统数据来评估错过的HPV疫苗接种机会的研究之一。
Human papillomavirus (HPV) vaccine 3-dose completion rates among adolescent females in the US are low. Missed opportunities impede HPV vaccination coverage. A population-based secondary data analysis of de-identified vaccination and demographic data from the Utah Statewide Immunization Information System (USIIS) was conducted. Records were included from 25,866 females ages 11–26 years at any time during 2008–2012 who received at least one of the following adolescent vaccinations documented in the USIIS: Tdap (Tetanus, Diphtheria, Pertussis), meningococcal, and/or influenza. A missed opportunity for HPV vaccination was defined as a clinical encounter where the patient received at least one adolescent vaccination, but not a HPV vaccine. Of 47,665 eligible visits, there were 20,911 missed opportunities (43.87%). Age group, race/ethnicity, and rurality were significantly associated with missed opportunity (p<0.0001). In a multivariable mixed-effects logistic regression model that included ethnicity, location and age, as fixed effects and subject as a random effect, Hispanics were less likely to have a missed opportunity than whites OR 0.59 (95% CI: 0.52–0.66), small rural more likely to have a missed opportunity than urban youth OR 1.8 (95% CI: 1.5–2.2), and preteens more likely than teens OR 2.4 (95% CI: 2.2–2.7). Missed clinical opportunities are a significant barrier to HPV vaccination among female adolescents. Interventions targeted at providers who serve patient groups with the highest missed opportunities are needed to achieve adequate protection from HPV-associated illnesses. This is one of the first studies to utilize state immunization information system data to assess missed opportunities for HPV vaccination.