An analysis of factors associated with influenza, pneumoccocal, Tdap, and herpes zoster vaccine uptake in the US adult population and corresponding inter-state variability.
An analysis of factors associated with influenza, pneumoccocal, Tdap, and herpes zoster vaccine uptake in the US adult population and corresponding inter-state variability.
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DOI：
10.1080/21645515.2017.1403697
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发表时间：
2018-02-01
影响因子：
4.8
通讯作者：
Hogea C
中科院分区：
文献类型：
--
作者：
La EM;Trantham L;Kurosky SK;Odom D;Aris E;Hogea C
尽管长期以来一直建议在美国普通成年人群中进行针对流感、肺炎球菌、破伤风、白喉、无细胞百日咳（Tdap）和带状疱疹（HZ）的常规疫苗接种，但疫苗接种率仍然很低。了解影响成人疫苗接种和覆盖率变化的因素是制定有针对性的战略以提高疫苗接种覆盖率的重要步骤。使用行为风险因素监测系统（2011-2014）的数据进行了回顾性分析。采用多变量逻辑回归模型确定与疫苗接种相关的个体因素（社会人口统计学、健康状况、医疗保健利用、居住州），并生成全国和各州调整后的疫苗接种覆盖率和依从性估计值。结果表明，在所有四种疫苗中，多种特征始终与更高的疫苗接种可能性相关，包括女性性别、教育程度的提高和家庭年收入。模型调整的疫苗接种覆盖率估计值因州而异，最近一年数据的州间变异性如下：流感（年龄≥18岁）30.2-49.5%;肺炎球菌（年龄≥65岁）64.0-74.7%; Tdap（年龄≥18岁）18.7-46.6%; HZ（年龄≥60岁）21.3- 42.9%。模型调整后的各疫苗对年龄相关建议的依从性较低，并且因州而异：流感+Tdap（18-59岁）7.9-24.7%;流感+Tdap+HZ（60-64岁）4.1-14.4%;流感+Tdap+HZ+肺炎球菌（≥65岁）3.0- 18.3%。总之，在调整与疫苗接种相关的个体特征后，各州之间仍存在显著异质性，表明其他当地因素（例如州政策）可能影响成人疫苗接种。需要进一步的研究来了解这些因素，重点是疫苗接种覆盖率高与低的州之间的差异。
Despite longstanding recommendations for routine vaccination against influenza; pneumococcal; tetanus, diphtheria, acellular pertussis (Tdap); and herpes zoster (HZ) among the United States general adult population, vaccine uptake remains low. Understanding factors that influence adult vaccination and coverage variability beyond the national level are important steps toward developing targeted strategies for increasing vaccination coverage. A retrospective analysis was conducted using data from the Behavioral Risk Factor Surveillance System (2011–2014). Multivariable logistic regression modeling was employed to identify individual factors associated with vaccination (socio-demographics, health status, healthcare utilization, state of residence) and generate adjusted vaccination coverage and compliance estimates nationally and by state. Results indicated that multiple characteristics were consistently associated with a higher likelihood of vaccination across all four vaccines, including female sex, increased educational attainment, and annual household income. Model-adjusted vaccination coverage estimates varied widely by state, with inter-state variability for the most recent year of data as follows: influenza (aged ≥18 years) 30.2–49.5%; pneumococcal (aged ≥65 years) 64.0–74.7%; Tdap (aged ≥18 years) 18.7–46.6%; and HZ (aged ≥60 years) 21.3–42.9%. Model-adjusted compliance with age-appropriate recommendations across vaccines was low and also varied by state: influenza+Tdap (aged 18–59 years) 7.9–24.7%; influenza+Tdap+HZ (aged 60–64 years) 4.1–14.4%; and influenza+Tdap+HZ+pneumococcal (aged ≥65 years) 3.0–18.3%. In summary, after adjusting for individual characteristics associated with vaccination, substantial heterogeneity across states remained, suggesting that other local factors (e.g. state policies) may be impacting adult vaccines uptake. Further research is needed to understand such factors, focusing on differences between states with high versus low vaccination coverage.
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