Pneumococcal vaccination coverage among adults newly diagnosed with underlying medical conditions and regional variation in the US
Pneumococcal vaccination coverage among adults newly diagnosed with underlying medical conditions and regional variation in the US
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DOI：
10.1016/j.vaccine.2022.06.068
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发表时间：
2022-08-10
期刊：
影响因子：
5.5
通讯作者：
Liu, Junqing
中科院分区：
文献类型：
--
作者：
Ostropolets, Anna;Dunham, Linda Shoener;Liu, Junqing
工作背景：美国疾病控制和预防中心的免疫实践咨询委员会建议慢性或免疫力低下的成年人接种肺炎球菌疫苗，以预防肺炎球菌疾病，但疫苗接种率很低，而且关于地区差异的信息有限。这项研究检查了与有基础疾病的成年人接种肺炎球菌疫苗相关的因素，并描述了美国各地接种疫苗的区域差异。使用IBM MarketScan商业数据库和Medicare补充数据库，这项回顾性队列研究包括年龄在19-64岁的新诊断为慢性在2013年，这些患者中的任何一个都可能患有疾病（即糖尿病、慢性心脏、肺或肝脏疾病、酒精或烟草依赖）或免疫功能低下（即癌症、慢性肾脏疾病、器官移植、HIV/AIDS和无脾）。成人随访至肺炎球菌疫苗接种、死亡或2019年12月31日，以先到者为准。考克斯比例风险模型用于检查与疫苗接种相关的因素。疫苗接种率按大都市统计区（MSA）计算，并在美国地图上直观表示。随访1年和5年的成年人疫苗接种率分别从6.0%上升到21.1%。成年人在首次确诊后平均需要2.4年才能接种疫苗。50-64岁、35-49岁（相对于19-34岁）或接受流感疫苗接种的成年人更有可能接受肺炎球菌疫苗接种。与糖尿病患者相比，患有艾滋病毒/艾滋病的成年人更有可能接种疫苗，而患有其他疾病的成年人接种疫苗的可能性较小。由其他提供者诊断的成年人接种疫苗的可能性低于由初级保健提供者诊断的成年人。疫苗接种率在MSA之间差异很大，范围从0.0%（艾姆斯，IA;夏延，WY）到34.0%（安阿伯，MI）。结论：肺炎球菌疫苗接种率仍然很低，大多数有基础疾病的成年人未接种疫苗。深入了解与疫苗接种相关的因素，包括区域差异，有助于增加肺炎球菌疫苗接种。(c)2022作者由爱思唯尔有限公司出版。这是一篇在CC BY-NC-ND许可证下的开放获取文章（http：//creativecommons.org/licenses/by-nc-nd/4.0/）。
Background: The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices recommends pneumococcal vaccination for adults with chronic or immunocompromising conditions to prevent pneumococcal disease, yet vaccination rates are low and have limited information on regional variation. This study examines factors associated with pneumococcal vaccination in adults with underlying conditions and describes regional variation in vaccination across the U.S.Methods: Using IBM MarketScan Commercial Database and Medicare Supplemental Database, this retrospective cohort study included adults ages 19-64 newly diagnosed with chronic (i.e. diabetes, chronic heart, lung, or liver disease, alcohol or tobacco dependence) or immunocompromising (i.e. cancer, chronic renal disease, organ transplant, HIV/AIDS, and asplenia) conditions in 2013. Adults were followed up until the time of pneumococcal vaccination, death, or December 31, 2019, whichever came first. Cox proportional hazards model was used to examine factors associated with vaccination. Vaccination rate was calculated by metropolitan statistical area (MSA) and visually represented on a U.S. map.Results: 255,330 adults were included. Vaccination rate increased from 6.0% to 21.1% among adults with one year and five years of follow-up, respectively. It took 2.4 years on average for adults to receive vaccination after initial diagnosis. Adults ages 50-64, 35-49 (relative to 19-34) or receiving influenza vaccination were more likely to receive pneumococcal vaccinations. Adults with HIV/AIDS were more likely and those with other conditions were less likely to be vaccinated than those with diabetes. Adults being diagnosed by other providers were less likely to be vaccinated than those diagnosed by primary care providers. Vaccination rate varied largely across MSAs, ranging from 0.0% (Ames, IA; Cheyenne, WY) to 34.0% (Ann Arbor, MI).Conclusion: Pneumococcal vaccination remains low and most adults with underlying conditions are unvaccinated. Insights into factors associated with vaccination, including regional variability, can help to increase pneumococcal vaccination.(c) 2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).