健康保险状况对成年人群疫苗接种覆盖率的影响。
Impact of health insurance status on vaccination coverage among adult populations.
作者信息
Lu Peng-jun, O'Halloran Alissa, Williams Walter W
机构信息
Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
出版信息
Am J Prev Med. 2015 Jun;48(6):647-61. doi: 10.1016/j.amepre.2014.12.008. Epub 2015 Apr 15.
INTRODUCTION
Underinsurance is a barrier to vaccination among children. Information on vaccination among adults aged ≥18 years by insurance status is limited. This study assesses vaccination coverage among adults aged ≥18 years in the U.S. in 2012 by health insurance status and access to care characteristics.
METHODS
The 2012 National Health Interview Survey data were analyzed in 2014 to estimate vaccination coverage among adults aged ≥18 years by health insurance status for seven routinely recommended vaccines.
RESULTS
Influenza vaccination coverage among adults aged ≥18 years without or with health insurance was 14.4% versus 44.3%, respectively; pneumococcal vaccination coverage among adults aged 18-64 years with high-risk conditions was 9.8% versus 23.0%; tetanus and diphtheria toxoid (Td) coverage (age ≥18 years) was 53.2% versus 64.5%; tetanus, diphtheria, and acellular pertussis (Tdap) coverage (age ≥18 years) was 8.4% versus 15.7%; hepatitis A (HepA) coverage (age 18-49 years) was 16.6% versus 19.8%; hepatitis B (HepB) coverage (age 18-49 years) was 27.5% versus 38.0%; shingles coverage (age ≥60 years) was 6.1% versus 20.8%; and human papillomavirus (HPV) coverage (women aged 18-26 years) was 20.9% versus 39.8%. In addition, vaccination coverage differed by insurance type, whether respondents had a regular physician, and number of physician contacts.
CONCLUSIONS
Overall, vaccination coverage among adults aged ≥18 years is lower among uninsured populations. Implementation of effective strategies is needed to help improve vaccination coverage among adults aged ≥18 years, especially those without health insurance.
引言
保险不足是儿童接种疫苗的一个障碍。关于18岁及以上成年人按保险状况划分的疫苗接种信息有限。本研究评估了2012年美国18岁及以上成年人按健康保险状况和获得医疗服务特征划分的疫苗接种覆盖率。
方法
2014年对2012年国家健康访谈调查数据进行分析，以估计18岁及以上成年人按健康保险状况划分的七种常规推荐疫苗的接种覆盖率。
结果
18岁及以上无健康保险或有健康保险的成年人中，流感疫苗接种覆盖率分别为14.4%和44.3%；18 - 64岁有高危状况的成年人中，肺炎球菌疫苗接种覆盖率为9.8%和23.0%；破伤风和白喉类毒素（Td）接种覆盖率（年龄≥18岁）为53.2%和64.5%；破伤风、白喉和无细胞百日咳（Tdap）接种覆盖率（年龄≥18岁）为8.4%和15.7%；甲型肝炎（HepA）接种覆盖率（年龄18 - 49岁）为16.6%和19.8%；乙型肝炎（HepB）接种覆盖率（年龄18 - 49岁）为27.5%和38.0%；带状疱疹疫苗接种覆盖率（年龄≥60岁）为6.1%和20.8%；人乳头瘤病毒（HPV）接种覆盖率（18 - 26岁女性）为20.9%和39.8%。此外，疫苗接种覆盖率因保险类型、受访者是否有固定医生以及医生接触次数而异。
结论
总体而言，18岁及以上成年人中，未参保人群的疫苗接种覆盖率较低。需要实施有效策略来帮助提高18岁及以上成年人的疫苗接种覆盖率，尤其是那些没有健康保险的人。
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