解释英格兰 HPV 疫苗接种率差异的原因。
Explaining variation in the uptake of HPV vaccination in England.
机构信息
Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
出版信息
BMC Public Health. 2011 Mar 22;11:172. doi: 10.1186/1471-2458-11-172.
BACKGROUND
In England, two national programmes of HPV vaccination for girls have been instituted, a routine programme for 12- and 13-year-olds and a catch-up programme for 17- and 18-year-olds. Uptake rates across the country have been far from uniform, and this research sought to identify factors explaining the variation in uptake by locality.
METHODS
An association between uptake, deprivation and ethnic background had been established in pilot research. The present analysis was conducted at an aggregate, Primary Care Trust (PCT), level for the first year of the programmes. Published measures of HPV vaccination uptake, material deprivation, ethnic composition of PCT populations, primary care quality, and uptake of cervical screening and of other childhood immunisations were collated. Strong evidence of collinearity amongst the explanatory variables required a factor analysis to be undertaken. This provided four independent factors, used thereafter in regression models to explain uptake by PCT.
RESULTS
The factor analysis revealed that ethnic composition was associated with attitudes towards cervical screening and other childhood vaccinations, whilst material deprivation and quality of primary care were orthogonal. Ethnic composition, early childhood vaccination, cervical screening and primary care quality were found to be influential in predicting uptake in both the routine and the catch-up cohorts, although with a lower degree of confidence in the case of the last two independent variables. Lower primary care quality was significant in explaining a greater fall in vaccination uptake between the first two doses in the catch-up cohort. Greater deprivation was a significant explanatory factor for both uptake and the fall in uptake between doses for the catch-up cohort but not for uptake in the routine cohort.
CONCLUSION
These results for uptake of the first year of the national programme using aggregate data corroborate findings from intentions surveys and pilot studies. Deprivation, the ethnic composition of the population, the effectiveness of primary care and the acceptability of childhood vaccinations are salient factors in explaining local HPV vaccine uptake in England.
背景
在英国，已经实施了两项针对女孩的 HPV 疫苗接种国家计划，一项是针对 12 至 13 岁女孩的常规计划，另一项是针对 17 至 18 岁女孩的补种计划。全国各地的接种率极不均衡，这项研究旨在确定解释当地接种率差异的因素。
方法
在试点研究中已经确定了接种率与贫困程度和族裔背景之间的关联。本分析是在该计划的第一年，在初级保健信托（PCT）的总体水平上进行的。收集了 HPV 疫苗接种率、物质贫困、PCT 人群的族裔构成、初级保健质量以及宫颈癌筛查和其他儿童免疫接种的接种率等方面的已发表数据。由于解释性变量之间存在很强的共线性，因此需要进行因子分析。这提供了四个独立的因素，此后用于回归模型来解释各 PCT 的接种率。
结果
因子分析表明，族裔构成与宫颈癌筛查和其他儿童疫苗接种的态度有关，而物质贫困和初级保健质量则是正交的。在常规和补种两组中，族裔构成、幼儿期疫苗接种、宫颈癌筛查和初级保健质量都被发现对预测接种率有影响，尽管在后两个独立变量的情况下，置信度较低。在补种组中，较低的初级保健质量对两剂之间疫苗接种率下降的解释力更大。贫困程度较高是补种组接种率和两剂之间接种率下降的重要解释因素，但对常规组接种率没有影响。
结论
这些使用汇总数据对国家计划第一年接种情况的结果与意向调查和试点研究的结果一致。贫困程度、人口的族裔构成、初级保健的有效性以及儿童疫苗接种的可接受性是解释英格兰 HPV 疫苗接种率的重要因素。
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