Burger Andrew E, Reither Eric N
Yun Kim Population Research Laboratory, Department of Sociology, Utah State University, 0730 Old Main Hill, Logan, UT 84322-0730, United States.
Vaccine. 2014 Jun 30;32(31):3950-4. doi: 10.1016/j.vaccine.2014.05.032. Epub 2014 May 18.
Despite the availability of vaccines that mitigate the health risks associated with seasonal influenza, most individuals in the U.S. remain unvaccinated. Monitoring vaccination uptake for seasonal influenza, especially among disadvantaged or high-risk groups, is therefore an important public health activity. The Behavioral Risk Factor Surveillance System (BRFSS) - the largest telephone-based health surveillance system in the world - is an important resource in monitoring population health trends, including influenza vaccination. However, due to limitations in the question that measures influenza vaccination status, difficulties arise in estimating seasonal vaccination rates. Although researchers have proposed various methodologies to address this issue, no systematic review of these methodologies exists. By subjecting these methods to tests of sensitivity and specificity, we identify their strengths and weaknesses and advance a new method for estimating national and state-level vaccination rates with BRFSS data. To ensure that our findings are not anomalous to the BRFSS, we also analyze data from the National Health Interview Survey (NHIS). For both studies, we find that restricting the sample to interviews conducted between January and September offers the best balance of sensitivity (>90% on average), specificity (>90% on average), and statistical power (retention of 92.2% of vaccinations from the target flu season) over other proposed methods. We conclude that including survey participants from these months provides a simple and effective way to estimate seasonal influenza vaccination rates with BRFSS and NHIS data, and we discuss potential ways to better estimate vaccination rates in future epidemiologic surveys.
尽管有疫苗可减轻与季节性流感相关的健康风险，但美国大多数人仍未接种疫苗。因此，监测季节性流感疫苗的接种情况，尤其是在弱势群体或高风险群体中的接种情况，是一项重要的公共卫生活动。行为风险因素监测系统（BRFSS）——世界上最大的基于电话的健康监测系统——是监测包括流感疫苗接种在内的人群健康趋势的重要资源。然而，由于衡量流感疫苗接种状况的问题存在局限性，在估计季节性疫苗接种率时会出现困难。尽管研究人员提出了各种方法来解决这个问题，但尚未对这些方法进行系统评价。通过对这些方法进行敏感性和特异性测试，我们确定了它们的优缺点，并提出了一种利用BRFSS数据估算国家和州一级疫苗接种率的新方法。为确保我们的研究结果与BRFSS不存在异常，我们还分析了国家健康访谈调查（NHIS）的数据。对于这两项研究，我们发现，将样本限制在1月至9月进行的访谈中，与其他提出的方法相比，在敏感性（平均>90%）、特异性（平均>90%）和统计效力（保留目标流感季节92.2%的疫苗接种记录）之间能实现最佳平衡。我们得出结论，纳入这些月份的调查参与者为利用BRFSS和NHIS数据估算季节性流感疫苗接种率提供了一种简单有效的方法，并且我们讨论了在未来流行病学调查中更好地估算疫苗接种率的潜在方法。
