Uptake of Pneumococcal Polysaccharide Vaccination Among Working-age Adults With Underlying Medical Conditions, United States, 2009
Uptake of Pneumococcal Polysaccharide Vaccination Among Working-age Adults With Underlying Medical Conditions, United States, 2009
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DOI：
10.1093/aje/kwr376
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发表时间：
2012-04-15
影响因子：
5
通讯作者：
Nuorti, J. Pekka
中科院分区：
文献类型：
--
作者：
Lu, Peng-Jun;Nuorti, J. Pekka
自1997年以来，免疫实践咨询委员会建议23价肺炎球菌多糖疫苗（PPSV 23）用于患有某些医疗条件的非老年成年人。2008年，委员会将哮喘和吸烟列入PPSV 23疫苗接种适应症清单。使用2009年国家健康访谈调查的数据，作者评估了PPSV 23在已确定和新适应症患者中的摄取情况。为了确定与接受PPSV 23独立相关的因素，他们使用了多变量逻辑回归和预测边际分析。2009年，共有3520万18-64岁的成年人（18.6%）确定了PPSV 23适应症;将哮喘和吸烟添加到适应症列表中使高危人群增加到7160万人（37.9%）。总体而言，26.1%的患者有明确的PPSV 23适应症，17.4%的患者有任何适应症50-64岁人群的总覆盖率明显高于18-49岁人群（34.6% vs. 16.7%; P < 0.001）和除癌症外的所有特定适应症。对于患有哮喘或吸烟但没有其他适应症的人，覆盖率分别为12.3%和8.5%。在已确定适应症的患者中，年龄较大、白色、失业、就诊次数较多、既往住院史、正规医生和健康保险与接受PPSV 23独立相关。PPSV 23的摄取量因年龄和适应症而异，但总体上仍然很低，约有5900万未接种疫苗的高风险工作年龄成人。需要采取有效的战略，在高危群体中增加肺炎球菌疫苗接种覆盖率。
Since 1997, the Advisory Committee on Immunization Practices has recommended the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for nonelderly adults with certain medical conditions. In 2008, the Committee added asthma and cigarette smoking to the list of indications for PPSV23 vaccination. Using data from the 2009 National Health Interview Survey, the authors assessed PPSV23 uptake in people with established and new indications. To identify factors independently associated with receiving PPSV23, they used multivariable logistic regression and predictive marginal analyses. In 2009, a total of 35.2 million adults 18-64 years of age (18.6%) had established PPSV23 indications; adding asthma and smoking to the list of indications increased the high-risk population to 71.6 million people (37.9%). Overall, 26.1% of people with established indications for PPSV23 and 17.4% of people with any indication (those previously established, as well as asthma and smoking) had received the vaccine; overall coverage among persons 50-64 years of age was significantly higher than that among persons 18-49 years of age (34.6% vs. 16.7%; P < 0.001) and for all specific indications except cancer. For persons who had asthma or who smoked but had no other indications, rates of coverage were 12.3% and 8.5%, respectively. In persons who had established indications, being older, white, and unemployed and having more physician visits, a prior hospitalization, a regular physician, and health insurance were independently associated with PPSV23 receipt. PPSV23 uptake varies substantially by age and indication but remains low overall, with approximately 59 million unvaccinated high-risk working-age adults. Effective strategies to increase pneumococcal vaccination coverage among at-risk groups are needed.