Geographic Disparity, Area Poverty, and Human Papillomavirus Vaccination
Geographic Disparity, Area Poverty, and Human Papillomavirus Vaccination
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DOI：
10.1016/j.amepre.2010.01.018
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发表时间：
2010-05-01
影响因子：
5.5
通讯作者：
Schootman, Mario
中科院分区：
文献类型：
--
作者：
Pruitt, Sandi L.;Schootman, Mario
背景：2006年，美国食品和药物管理局批准一种人乳头瘤病毒(HPV)疫苗在妇女/女孩中使用。从那时起，只有有限的研究检查了青春期女孩对HPV疫苗的接受情况，没有研究检查地理差异在HPV疫苗接种中的作用。目的：本研究的目的是检查人乳头瘤病毒(HPV)疫苗接种流行的地理差异，并检查个人-县方法：利用2008年美国行为危险因素监测系统(BRFSS)和2000年美国人口普查的数据，对美国6个州13~17岁女孩的数据进行三水平随机截距多水平Logistic回归分析。结果：纳入274个县和6个州的1709名女孩的嵌套数据。女孩主要是白人(70.6%)和有保险(74.5%)。总体而言，34.4%的女孩接种了疫苗。州(方差=0.134，SE=0.065)和县(方差=0.146，SE=0.063)之间存在显著的地理差异，这在一定程度上是由州和县的贫困程度造成的。与个人因素无关，贫困在州和县一级产生不同的影响：贫困程度越高的州的女孩接种疫苗的可能性越小，而贫困程度越高的县的女孩接种疫苗的可能性越大。家庭收入与县级贫困呈现相似的模式：与最高收入家庭的女孩相比，最低收入家庭的女孩更有可能接种HPV疫苗。结论：本研究结果表明，HPV疫苗接种的地理差异。虽然州级贫困程度越高，接种疫苗的可能性越低，但县级贫困程度越高，家庭收入越低，接种疫苗的可能性就越高。需要进行研究以更好地了解这些差异，并为干预措施提供信息，以便在所有符合条件的女孩中增加疫苗接种。(Am J Prey Med 2010；38(5)：525-533)(C)2010年美国预防医学杂志
Background: A human papillomavirus (HPV) vaccine was approved by the Food and Drug Administration for use among women/girls in 2006. Since that time, limited research has examined HPV vaccine uptake among adolescent girls and no studies have examined the role of geographic disparities in HPV vaccination.Purpose: The purpose of this study is to examine geographic disparity in the prevalence of human papillomavirus (HPV) vaccination and to examine individual-, county-, and state-level correlates of vaccination.Methods: Three-level random intercept multilevel logistic regression models were fitted to data from girls aged 13-17 years living in six U.S. states using data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) and the 2000 U.S. census.Results: Data from 1709 girls nested within 274 counties and six states were included. Girls were predominantly white (70.6%) and insured (74.5%). Overall, 34.4% of girls were vaccinated. Significant geographic disparity across states (variance =0.134, SE=0.065) and counties (variance=0.146, SE=0.063) was present, which was partially explained by state and county poverty levels. Independent of individual-level factors, poverty had differing effects at the state and county level: girls in states with higher levels of poverty were less likely whereas girls in counties with higher poverty levels were more likely to be vaccinated. Household income demonstrated a similar pattern to that of county-level poverty: Compared to girls in the highest-income families, girls in the lowest-income families were more likely to be vaccinated.Conclusions: The results of this study suggest geographic disparity in HPV vaccination. Although higher state-level poverty is associated with a lower likelihood of vaccination, higher county-level poverty and lower income at the family level is associated with a higher likelihood of vaccination. Research is needed to better understand these disparities and to inform interventions to increase vaccination among all eligible girls. (Am J Prey Med 2010;38(5):525-533) (C) 2010 American Journal of Preventive Medicine