Lu Peng-Jun, O'Halloran Alissa, Williams Walter W, Harpaz Rafael
Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Prev Med. 2017 Mar;52(3):362-372. doi: 10.1016/j.amepre.2016.08.031. Epub 2016 Oct 5.
Shingles (herpes zoster) causes substantial morbidity, especially among older adults. The shingles vaccine has been recommended for people aged ≥60 years since 2006. This study assessed recent shingles vaccination at national and state levels among adults aged ≥60 years.
The 2014 Behavioral Risk Factor Surveillance System data were analyzed in 2015 to assess shingles vaccination coverage among adults aged ≥60 years at national and state levels. Multivariable logistic regression and predictive marginal models identified factors independently associated with vaccination.
Shingles vaccination coverage among adults aged ≥60 years was 31.8% (95% CI=31.4%, 32.2%). Among states, shingles vaccination coverage ranged from 17.8% (95% CI=15.8%, 20.0%) in Mississippi to 46.6% (95% CI=44.3%, 48.8%) in Vermont, with a median of 33.3%. Coverage was <25% in four states and >40% in nine states. For all states, coverage was significantly higher among non-Hispanic whites compared with non-white races except for Oregon, with coverage differences ranging from -33.2% in the District of Columbia to 0.9% in Oregon and a median of -16.0%. Characteristics independently associated with vaccination were age, race/ethnicity, sex, education, employment status, household income, region, perceived health status, health insurance status, personal healthcare provider, routine checkup status, and whether reporting that cost was a barrier to seeing a doctor.
Coverage varied dramatically by state. State-level comparisons may aid in designing tailored intervention programs through sharing of best practices. Strategies are needed to mitigate financial barriers for both provider and patients, improve awareness, and increase provider recommendation of the vaccine.
带状疱疹会引发严重疾病，尤其是在老年人中。自2006年起，带状疱疹疫苗就被推荐给60岁及以上的人群。本研究评估了60岁及以上成年人在国家和州层面的近期带状疱疹疫苗接种情况。
2015年对2014年行为危险因素监测系统的数据进行了分析，以评估国家和州层面60岁及以上成年人的带状疱疹疫苗接种覆盖率。多变量逻辑回归和预测边际模型确定了与疫苗接种独立相关的因素。
60岁及以上成年人的带状疱疹疫苗接种覆盖率为31.8%（95%置信区间=31.4%，32.2%）。在各州中，带状疱疹疫苗接种覆盖率从密西西比州的17.8%（95%置信区间=15.8%，20.0%）到佛蒙特州的48.8%（95%置信区间=44.3%，48.8%）不等，中位数为33.3%。四个州的覆盖率低于25%，九个州的覆盖率高于40%。对于所有州，除俄勒冈州外，非西班牙裔白人的覆盖率显著高于非白人种族，覆盖率差异从哥伦比亚特区的-33.2%到俄勒冈州的0.9%不等，中位数为-16.0%。与疫苗接种独立相关的特征包括年龄、种族/族裔、性别、教育程度、就业状况、家庭收入、地区、自我感知的健康状况、健康保险状况、个人医疗服务提供者、定期体检状况，以及是否报告费用是看医生的障碍。
各州的覆盖率差异很大。州层面的比较可能有助于通过分享最佳实践来设计量身定制的干预项目。需要采取策略来减轻提供者和患者的经济障碍，提高认识，并增加提供者对该疫苗的推荐。
