Nelson Erik J, Hughes John, Oakes J Michael, Pankow James S, Kulasingam Shalini L
Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, USA.
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
BMJ Open. 2015 Aug 27;5(8):e008617. doi: 10.1136/bmjopen-2015-008617.
To identify factors associated with human papillomavirus (HPV) vaccination and to determine the geographic distribution of vaccine uptake while accounting for spatial autocorrelation.
This study is cross-sectional in design using data collected via the Internet from the Survey of Minnesotans About Screening and HPV study.
The sample consists of 760 individuals aged 18-30 years nested within 99 ZIP codes surrounding the downtown area of Minneapolis, Minnesota.
In all, 46.2% of participants had received ≥ 1 dose of HPV vaccine (67.7% of women and 13.0% of men). Prevalence of HPV vaccination was found to exhibit strong spatial dependence ([Formula: see text] = 0.9951) across ZIP codes. Accounting for spatial dependence, age (OR=0.76, 95% CI 0.70 to 0.83) and male gender (OR=0.04, 95% CI 0.03 to 0.07) were negatively associated with vaccination, while liberal political preferences (OR=4.31, 95% CI 2.32 to 8.01), and college education (OR=2.58, 95% CI 1.14 to 5.83) were found to be positively associated with HPV vaccination.
Strong spatial dependence and heterogeneity of HPV vaccination prevalence were found across ZIP codes, indicating that spatial statistical models are needed to accurately identify and estimate factors associated with vaccine uptake across geographic units. This study also underscores the need for more detailed data collected at local levels (eg, ZIP code), as patterns of HPV vaccine receipt were found to differ significantly from aggregated state and national patterns. Future work is needed to further pinpoint areas with the greatest disparities in HPV vaccination and how to then access these populations to improve vaccine uptake.
确定与人乳头瘤病毒（HPV）疫苗接种相关的因素，并在考虑空间自相关性的情况下确定疫苗接种率的地理分布。
本研究采用横断面设计，使用通过互联网从明尼苏达人筛查与HPV研究调查中收集的数据。
样本包括99个邮政编码区域内的760名年龄在18 - 30岁的个体，这些邮政编码区域围绕明尼苏达州明尼阿波利斯市中心。
总体而言，46.2%的参与者接种了≥1剂HPV疫苗（女性为67.7%，男性为13.0%）。发现HPV疫苗接种率在邮政编码区域间呈现出很强的空间依赖性（[公式：见正文] = 0.9951）。考虑到空间依赖性，年龄（比值比=0.76，95%置信区间0.70至0.83）和男性性别（比值比=0.04，95%置信区间0.03至0.07）与疫苗接种呈负相关，而自由派政治倾向（比值比=4.31，95%置信区间2.32至8.01）和大学教育程度（比值比=2.58，95%置信区间1.14至5.83）与HPV疫苗接种呈正相关。
在邮政编码区域间发现了HPV疫苗接种率的强空间依赖性和异质性，这表明需要空间统计模型来准确识别和估计跨地理单元与疫苗接种相关的因素。本研究还强调了需要在地方层面（如邮政编码区域）收集更详细的数据，因为发现HPV疫苗接种模式与汇总的州和国家模式有显著差异。未来需要开展进一步工作，以进一步确定HPV疫苗接种差异最大的地区，以及如何接触这些人群以提高疫苗接种率。
