Jain Anu, van Hoek A J, Boccia Delia, Thomas Sara L
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; Immunisation, Hepatitis and Blood Safety Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Vaccine. 2017 Apr 25;35(18):2315-2328. doi: 10.1016/j.vaccine.2017.03.013. Epub 2017 Mar 27.
Vaccination is a key intervention to reduce infectious disease mortality and morbidity amongst older individuals. Identifying social factors for vaccine uptake enables targeted interventions to reduce health inequalities.
To systematically appraise and quantify social factors associated with vaccine uptake amongst individuals aged ≥60years from Europe.
We searched Medline and Embase from inception to 24/02/2016. The association of vaccine uptake was examined for social factors relevant at an individual level, to provide insight into individuals' environment and enable development of targeted interventions by healthcare providers to deliver equitable healthcare. Factors included: living alone, marital status, education, income, vaccination costs, area-level deprivation, social class, urban versus rural residence, immigration status and religion. Between-study heterogeneity for each factor was identified using I-statistics and Q-statistics, and investigated by stratification and meta-regression analysis. Meta-analysis was conducted, when appropriate, using fixed- or random-effects models.
From 11,754 titles, 35 eligible studies were identified (uptake of: seasonal influenza vaccine (SIV) only (n=27) or including pneumococcal vaccine (PV) (n=5); herpes zoster vaccine (n=1); pandemic influenza vaccine (n=1); PV only (n=1)). Higher SIV uptake was reported for individuals not living alone (summary odds ratios (OR)=1.39 (95% confidence interval (CI): 1.16-1.68). Lower SIV uptake was observed in immigrants and in more deprived areas: summary OR=0.57 (95%CI: 0.47-0.68) and risk ratio=0.93 (95%CI: 0.92-0.94) respectively. Higher SIV uptake was associated with higher income (OR=1.26 (95%CI: 1.08-1.47)) and higher education (OR=1.05 (95%CI: 1-1.11)) in adequately adjusted studies. Between-study heterogeneity did not appear to result from variation in categorisation of social factors, but for education was partly explained by varying vaccination costs (meta-regression analysis p=<0.0001); individuals with higher education had higher vaccine uptake in countries without free vaccination.
Quantification of associations between social factors and lower vaccine uptake, and notably living alone (an overlooked factor in vaccination programmes), should enable health professionals target specific social groups to tackle vaccine-related inequalities.
接种疫苗是降低老年人传染病死亡率和发病率的关键干预措施。确定影响疫苗接种的社会因素有助于采取针对性干预措施，减少健康不平等现象。
系统评估和量化欧洲60岁及以上人群中与疫苗接种相关的社会因素。
我们检索了从数据库建立至2016年2月24日的Medline和Embase数据库。研究了个体层面相关社会因素与疫苗接种之间的关联，以了解个体所处环境，并使医疗服务提供者能够制定针对性干预措施，提供公平的医疗服务。这些因素包括：独居、婚姻状况、教育程度、收入、疫苗接种费用、地区贫困程度、社会阶层、城乡居住情况、移民身份和宗教信仰。使用I统计量和Q统计量确定各因素研究间的异质性，并通过分层分析和Meta回归分析进行调查。在适当情况下，使用固定效应或随机效应模型进行Meta分析。
从11754篇标题中，确定了35项符合条件的研究（疫苗接种情况：仅接种季节性流感疫苗（SIV）（n = 27）或包括肺炎球菌疫苗（PV）（n = 5）；带状疱疹疫苗（n = 1）；大流行性流感疫苗（n = 1）；仅接种PV（n = 1））。报告显示，非独居个体的SIV接种率较高（汇总比值比（OR）= 1.39（95%置信区间（CI）：1.16 - 1.68））。在移民和贫困程度较高的地区观察到较低的SIV接种率：汇总OR分别为0.57（95%CI：0.47 - 0.68）和风险比为0.93（95%CI：0.92 - 0.94）。在充分调整的研究中，较高的SIV接种率与较高收入（OR = 1.26（95%CI：1.08 - 1.47））和较高教育程度（OR = 1.05（95%CI：1 - 1.11））相关。研究间的异质性似乎并非由社会因素分类的差异导致，但对于教育程度而言，部分原因是疫苗接种费用不同（Meta回归分析p < 0.0001）；在没有免费疫苗接种的国家，教育程度较高的个体疫苗接种率更高。
对社会因素与较低疫苗接种率之间关联的量化，尤其是独居（疫苗接种计划中一个被忽视的因素），应能使卫生专业人员针对特定社会群体，解决与疫苗相关的不平等问题。
