Mangtani Punam, Breeze Elizabeth, Kovats Sari, Ng Edmond S W, Roberts Jennifer A, Fletcher Astrid
London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Prev Med. 2005 Aug;41(2):545-53. doi: 10.1016/j.ypmed.2005.02.001.
In the UK, payments to providers (General Practitioners) for vaccinating all people aged over 64 years old against influenza commenced in 2000. Little information exists on the relationship between uptake and need. We assessed factors influencing uptake and equity in uptake in over 74 year olds.
We analysed cohort data from 5572 subjects in a community-based trial. Analyses took into account clustering and location of general practices in terms of Underprivileged Area (UPA) Score and area Standardised Mortality Ratio (SMR).
Vaccine uptake in practices in the most deprived tertile was 0.88 (95% CI 0.80-0.96) that of the least deprived and mid tertile, adjusted for confounding. Within each deprivation tertile, uptake in the mid and highest SMR tertile was 0.86 (95% CI 0.79, 0.94) and 0.87 (95% CI 0.81, 0.95) that of the lowest respectively. Uptake was 10% lower at the most in individuals with poorer quality housing. Higher uptake if married or with respiratory conditions and lower uptake if smoked had cognitive impairment or depression did not explain the socioeconomic differentials.
Lower uptake in practices in deprived areas supports targeting of resources. At the individual level, those who are more isolated require support to access influenza vaccination.
在英国，自2000年起开始向为所有64岁以上人群接种流感疫苗的医疗机构（全科医生）支付费用。关于接种率与需求之间的关系，现有信息较少。我们评估了影响74岁以上人群接种率及接种公平性的因素。
我们分析了一项基于社区试验中5572名受试者的队列数据。分析考虑了根据贫困地区（UPA）评分和地区标准化死亡率（SMR）划分的全科医疗的聚类情况和地理位置。
在调整混杂因素后，最贫困三分位地区的医疗机构的疫苗接种率是最不贫困和中等贫困三分位地区的0.88（95%可信区间0.80 - 0.96）。在每个贫困三分位地区内，中等和最高SMR三分位地区的接种率分别是最低SMR三分位地区的0.86（95%可信区间0.79，0.94）和0.87（95%可信区间0.81，0.95）。住房质量较差的个体接种率最高降低10%。已婚或患有呼吸系统疾病者接种率较高，而吸烟者、有认知障碍或抑郁症者接种率较低，这些并不能解释社会经济差异。
贫困地区医疗机构的接种率较低，这支持了资源的针对性分配。在个体层面，那些更为孤立的人群需要获得支持以接种流感疫苗。
