Social determinants of health and adult influenza vaccination: a nationwide claims analysis
Social determinants of health and adult influenza vaccination: a nationwide claims analysis
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DOI：
10.18553/jmcp.2022.28.2.196
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发表时间：
2022-02-01
影响因子：
2.1
通讯作者：
Chiu, Chi-Yang
中科院分区：
文献类型：
--
作者：
Gatwood, Justin;Ramachandran, Sujith;Chiu, Chi-Yang
背景技术背景：年度流感疫苗的健康和经济效益有据可查，但美国的疫苗接种率没有达到2020年健康人民的目标，仍然是2030年健康人民努力的重点。通过确定年度流感疫苗接种率低的根本原因，可以确定需要针对的社会因素，并可以指导未来的干预措施或政策制定，以实现疫苗接种目标并改善整体公共卫生。目的：为了确定某些社会健康决定因素对美国成年人每年流感疫苗接种依从性的影响，方法：这是一项回顾性队列分析，使用IBM MarketScan商业索赔和遭遇数据库的数据和2013年至2016年的国家医疗保险5%样本数据。研究合格性标准包括在2013年至2016年期间连续入组3个流感季节的成人（18岁及以上）。在连续3个流感季节中对流感疫苗接种进行计数，并从公开来源中提取选定的社会决定因素。患者特征、卫生资源利用和选定的健康社会决定因素被纳入双变量和多变量逻辑回归分析，以确定其与每年流感疫苗接种的相关性。对雇主赞助和医疗保险覆盖组的6，694，571名成年人进行了分析，其中14.7%的Medicare登记成人和9.2%的商业登记成人在所有3个季节接种了疫苗。疫苗坚持率较高（即，所有3个季节）在女性中观察到（9.6%对8.7% [商业]，15.0%对14.4% [医疗保险]），免疫功能低下（11.8%对8.3% [商业]，15.9%对13.6% [医疗]），农村居民（10.5%对9.0% [商业]，15.4%对14.6% [医疗保险];所有P < 0.0001），以及参加高免赔额健康计划的人（10.3%）。多变量逻辑回归模型表明，在贫困程度较高的地区，（OR = 1.012; 95% CI = 1.01-1.02 [商业]，OR = 1.01; 95% CI = 1.01-1.01 [医疗保险]）但在民主党选民比例较高的地区较低（OR = 0.998; 95% CI = 0.998-0.998 [商业]，OR = 0.996; 95% CI = 0.996-0.997 [医疗保险]）。在商业保险的成年人中，在健康素养较高的地区，疫苗依从性的几率较高（OR = 1.036; 95%CI = 1.036-1.037），但在医疗保险成员中没有观察到这种影响。相反，疫苗依从性的几率增加的比例，居住在互联网接入有限的地区增加（OR = 1.007; 95%CI = 1.004-1.010）之间的Medicare members only.CONCLUSIONS：健康的关键社会决定因素是疫苗依从性的重要因素，可以指导政策和干预措施，以解决潜在的犹豫。需要对季节性流感和其他疫苗中的其他社会因素进行更深入的评估，以更好地解释成年人的疫苗寻求行为。
BACKGROUND: The health and economic benefits of the annual influenza vaccine are well documented, yet vaccination rates in the United States missed the Healthy People 2020 goal and remain a focus of Healthy People 2030 efforts. By identifying underlying reasons for low annual influenza vaccination, social elements that need targeting may be identified and could guide future interventions or policy development to achieve vaccination goals and improve overall public health. OBJECTIVE: To determine the influence of certain social determinants of health on adherence to annual influenza vaccination in American adults.METHODS: This was a retrospective cohort analysis using data from IBM MarketScan Commercial Claims and Encounters Database and national Medicare 5% sample data from 2013 to 2016. Study eligibility criteria included adults (aged 18 years and older) who were continuously enrolled for 3 influenza seasons between 2013 and 2016. Receipt of the influenza vaccine was counted over 3 consecutive influenza seasons, and select social determinants were extracted from publicly available sources. Patient characteristics, health resource utilization, and selected social determinants of health were included in bivariate and multivariate logistic regression analyses to determine their association with annual influenza vaccination.RESULTS: 6,694,571 adults across employer sponsored and Medicare coverage groups were analyzed, of which 14.7% of Medicare-enrolled adults and 9.2% of commercially enrolled adults were vaccinated in all 3 seasons. Higher proportions of vaccine adherence (ie, all 3 seasons) were observed among females (9.6% vs 8.7% [commercial], 15.0% vs 14.4% [Medicare]), the immunocompromised (11.8% vs 8.3% [commercial], 15.9% vs 13.6% [Medicare]), rural residents (10.5% vs 9.0% [commercial], 15.4% vs 14.6% [Medicare]; all P < 0.0001), and those enrolled in a high-deductible health plan (10.3%). Multivariable logistic regression models indicated that the odds of vaccine adherence tended to be higher in areas of higher poverty (OR = 1.012; 95% CI = 1.01-1.02 [commercial], OR = 1.01; 95% CI = 1.01-1.01 [Medicare]) yet lower in areas with higher proportions of Democratic voters (OR = 0.998; 95% CI = 0.998-0.998 [commercial], OR = 0.996; 95% CI = 0.996-0.997 [Medicare]). Among commercially insured adults, the odds of vaccine adherence were higher in areas of higher health literacy (OR = 1.036; 95% CI = 1.036-1.037), but this effect was not observed among Medicare members. Conversely, the odds of vaccine adherence increased as the proportion of those residing in areas of limited Internet access increased (OR = 1.007; 95% CI = 1.004-1.010) among Medicare members only.CONCLUSIONS: Key social determinants of health are important factors of vaccine adherence and can guide policy and intervention efforts toward addressing potential hesitancy. A deeper assessment of other contributing social factors is needed in seasonal influenza and other vaccines to better interpret the vaccine-seeking behaviors of adults.