Evaluation of Vaccination Strategies to Compare Efficient and Equitable Vaccine Allocation by Race and Ethnicity Across Time.
Evaluation of Vaccination Strategies to Compare Efficient and Equitable Vaccine Allocation by Race and Ethnicity Across Time.
复制标题
DOI：
10.1001/jamahealthforum.2021.2095
复制
发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Liu VX
中科院分区：
文献类型：
--
作者：
Kipnis P;Soltesz L;Escobar GJ;Myers L;Liu VX
不同的疫苗分配策略与COVID-19相关的发病率和死亡率之间的关系，以及它们在不同时间按种族和民族群体的分布情况？在该决策分析模型中，模拟了基于风险、基于年龄和美国疾病控制和预防中心（CDC）分阶段疫苗分配策略的使用。与CDC和基于年龄的策略相比，基于风险的策略与非选择性住院，死亡和家庭传播的最大估计减少相关，与CDC策略相比，西班牙裔和黑人患者在早期接种疫苗的比例相似。研究结果表明，基于风险的疫苗优先策略可能在减少COVID-19相关死亡和家庭传播方面具有最大的有效性，同时确保公平的疫苗分配。确定最有效的COVID-19疫苗分配策略可能会大幅减少住院治疗并挽救生命，同时确保公平的疫苗分配。模拟不同疫苗分配策略与COVID-19相关发病率和死亡率及其在种族和族裔群体中的分布之间的关联。我们在随机分割的训练和验证数据集上开发并内部验证了COVID-19感染风险和住院风险模型。这些被用于一个计算机模拟研究的成人健康计划的成员谁是从一个综合的医疗保健提供系统绘制的疫苗优先级。该研究于2021年1月3日至2021年6月1日在加州的奥克兰进行，并对同期数据进行了分析。我们模拟了不同疫苗分配策略（包括（1）随机，（2）美国疾病控制和预防中心（CDC）代理，（3）基于年龄，以及（4）不良结局风险（CRS）和COVID-19感染（PROVID）模型的组合）与2020年5月1日至2020年12月31日期间COVID-19相关住院的关联。在250次模拟中，按月随机排列，并按种族和民族评估疫苗分配，以及随时间推移的社区剥夺指数。该研究包括3202679名成年患者（平均[SD]年龄，48.2 [18.0]岁; 1 677 637名女性[52.4%]; 1 525 042名男性[47.6%]; 611154名亚洲人[19.1%]、206363名黑人[6.4%]、642344名西班牙裔[20.1%]和1390638名白色人[43.4%]），其中36137名（1.1%）为SARS-CoV-2阳性。基于风险的策略（CRS/PROVID）显示最大的可避免住院估计值（4954; 95% CI，3452-5878），其次是基于年龄的策略（4362; 95% CI，2866-5175）和CDC代理策略（4085; 95% CI，2805-5109）。随机疫苗接种显示不良后果的减少程度大大降低。基于风险的策略还显示，可避免的COVID-19死亡人数（CRS/PROVID联合）和家庭传播人数最多。据估计，基于风险的（PROVID）和CDC代理策略在8个月内为西班牙裔和黑人患者接种疫苗的比例最高（联合CRS/PROVID：642 570 [100%]西班牙裔，185 530 [90%]黑人; PROVID：642 570 [100%]西班牙裔，198 480 [96%]黑人; CDC代理：605 770 [95%]西班牙裔和151 772 [74%]黑人）与基于年龄的方法（438 423 [68%]西班牙裔，154 714 [75%]黑人）相比。总体而言，PROVID和联合CRS/PROVID基于风险的策略估计会被大多数来自高邻里贫困指数地区的患者提前接种疫苗。在这项对来自大型综合医疗保健提供系统的成年人进行的模拟建模研究中，与CDC代理和基于年龄的策略相比，基于风险的策略与COVID-19住院，死亡和家庭传播的最大估计减少相关，与CDC策略相比，西班牙裔和黑人患者的比例估计更高。该决策分析模型模拟了不同疫苗分配策略与COVID-19相关发病率和死亡率及其在种族和族裔群体中的分布之间的关联。
What is the association of different vaccine allocation strategies with COVID-19–related morbidity and mortality and their distribution by racial and ethnic groups across time? In this decision analytical model, the use of risk-based, age-based, and US Centers for Disease Control and Prevention (CDC)–phased vaccine allocation strategies was simulated. Risk-based strategies were associated with the largest estimated reductions in nonelective hospitalizations, death, and household transmissions compared with the CDC- and age-based strategies, with a similar proportion of Hispanic and Black patients being vaccinated early in the process compared with the CDC strategy. The study findings suggest that risk-based vaccine prioritization strategies could have the greatest effectiveness on reducing COVID-19–related deaths and household transmissions while ensuring equitable vaccine distribution. Identifying the most efficient COVID-19 vaccine allocation strategy may substantially reduce hospitalizations and save lives while ensuring an equitable vaccine distribution. To simulate the association of different vaccine allocation strategies with COVID-19–associated morbidity and mortality and their distribution across racial and ethnic groups. We developed and internally validated the risk of COVID-19 infection and risk of hospitalization models on randomly split training and validation data sets. These were used in a computer simulation study of vaccine prioritization among adult health plan members who were drawn from an integrated health care delivery system. The study was conducted from January 3, 2021, to June 1, 2021, in Oakland, California, and the data were analyzed during the same period. We simulated the association of different vaccine allocation strategies, including (1) random, (2) a US Centers for Disease Control and Prevention (CDC) proxy, (3) age based, and (4) combinations of models for the risk of adverse outcomes (CRS) and COVID-19 infection (PROVID), with COVID-19-related hospitalizations between May 1, 2020, and December 31, 2020, that were randomly permuted by month across 250 simulations and assessed vaccine allocation by race and ethnicity and the neighborhood deprivation index across time. The study included 3 202 679 adult patients (mean [SD] age, 48.2 [18.0] years; 1 677 637 women [52.4%]; 1 525 042 men [47.6%]; 611 154 Asian [19.1%], 206 363 Black [6.4%], 642 344 Hispanic [20.1%], and 1 390 638 White individuals [43.4%]), of whom 36 137 (1.1%) were positive for SARS-CoV-2. A risk-based strategy (CRS/PROVID) showed the largest avoidable hospitalization estimates (4954; 95% CI, 3452-5878) followed by age-based (4362; 95% CI, 2866-5175) and CDC proxy (4085; 95% CI, 2805-5109) strategies. Random vaccination showed substantially lower reductions in adverse outcomes. Risk-based strategies also showed the largest number of avoidable COVID-19 deaths (joint CRS/PROVID) and household transmissions. Risk-based (PROVID) and CDC proxy strategies were estimated to vaccinate the highest percentage of Hispanic and Black patients in 8 months (joint CRS/PROVID: 642 570 [100%] Hispanic, 185 530 [90%] Black; PROVID: 642 570 [100%] Hispanic, 198 480 [96%] Black; CDC proxy: 605 770 [95%] Hispanic and 151 772 [74%] Black) compared with an age-based approach (438 423 [68%] Hispanic, 154 714 [75%] Black). Overall, the PROVID and joint CRS/PROVID risk-based strategies were estimated to be followed by the most patients from areas with high neighborhood deprivation index being vaccinated early. In this simulation modeling study of adults from a large integrated health care delivery system, risk-based strategies were associated with the largest estimated reductions in COVID-19 hospitalizations, deaths, and household transmissions compared with the CDC proxy and age-based strategies, with a higher proportion of Hispanic and Black patients were estimated to be vaccinated early in the process compared with the CDC strategy. This decision analytical model simulates the association of different vaccine allocation strategies with COVID-19–associated morbidity and mortality and their distribution across racial and ethnic groups.