Ward Charlotte, Byrne Lisa, White Joanne M, Amirthalingam Gayatri, Tiley Karen, Edelstein Michael
Immunisation, Hepatitis and Blood Safety Department, National Infections Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Immunisation, Hepatitis and Blood Safety Department, National Infections Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK.
Vaccine. 2017 Apr 25;35(18):2372-2378. doi: 10.1016/j.vaccine.2017.03.042. Epub 2017 Mar 28.
In September 2013, England introduced a shingles vaccination programme to reduce incidence and severity of shingles in the elderly. This study aims to assess variation in vaccine coverage with regards to selected sociodemographic factors to inform activities for improving equity of the programme.
Eligible 70year-olds were identified from a national vaccine coverage dataset in 2014/15 that includes 95% of GPs in England. NHS England Local Team (LT) and index of multiple deprivation (IMD) scores were assigned to patients based on GP-postcode. Vaccine coverage (%) with 95% confidence intervals (CIs), were calculated overall and by LT, ethnicity and IMD, using binomial regression.
Of 502,058 eligible adults, 178,808 (35.6%) had ethnicity recorded. Crude vaccine coverage was 59.5% (95%CI: 59.3-59.7). Coverage was lowest in London (49.6% coverage, 95%CI: 49.0-50.2), and compared to this coverage was significantly higher in all other LTs (+6.3 to +10.4, p<0.001) after adjusting for ethnicity and IMD. Coverage decreased with increasing deprivation and was 8.2% lower in the most deprived (95%CI: 7.3-9.1) compared with the least deprived IMD quintile (64.1% coverage, 95%CI: 63.6-64.6), after adjustment for ethnicity and LT. Compared with White-British (60.7% coverage, 95%CI: 60.5-61.0), other ethnic groups had between 4.0% (Indian) and 21.8% (Mixed: White and Black African) lower coverage. After adjusting for IMD and LT, significantly lower coverage by ethnicity persisted in all groups, except in Mixed: Other, Indian and Bangladeshi compared with White-British.
After taking geography and deprivation into account, shingles vaccine coverage varied by ethnicity. White-British, Indian and Bangladeshi groups had highest coverage; Mixed: White and Black African, and Black-other ethnicities had the lowest. Patients' ethnicity and IMD are predictors of coverage which contribute to, but do not wholly account for, geographical variation coverage. Interventions to address service-related, sociodemographic and ethnic inequalities in shingles vaccine coverage are required.
2013年9月，英国推出了一项带状疱疹疫苗接种计划，以降低老年人带状疱疹的发病率和严重程度。本研究旨在评估特定社会人口学因素对疫苗接种覆盖率的影响，为改善该计划的公平性提供依据。
从2014/15年度的全国疫苗接种覆盖率数据集中识别出符合条件的70岁老人，该数据集涵盖了英格兰95%的全科医生。根据全科医生的邮政编码为患者分配英格兰国民医疗服务体系地方团队（LT）和多重剥夺指数（IMD）分数。使用二项式回归计算总体以及按LT、种族和IMD划分的疫苗接种覆盖率（%）及其95%置信区间（CI）。
在502,058名符合条件的成年人中，有178,808人（35.6%）记录了种族信息。粗疫苗接种覆盖率为59.5%（95%CI：59.3 - 59.7）。伦敦的覆盖率最低（49.6%，95%CI：49.0 - 50.2），在调整种族和IMD因素后，与伦敦相比，所有其他地方团队的覆盖率显著更高（提高6.3至10.4个百分点，p<0.001）。随着贫困程度的增加，覆盖率下降，在调整种族和LT因素后，最贫困地区的覆盖率比最不贫困的IMD五分位数地区低8.2%（95%CI：7.3 - 9.1）（最不贫困地区的覆盖率为64.1%，95%CI：63.6 - 64.6）。与英国白人（覆盖率60.7%，95%CI：60.5 - 61.0）相比，其他种族群体的覆盖率低4.0%（印度裔）至21.8%（混血：白人和非洲黑人）。在调整IMD和LT因素后，除混血：其他、印度裔和孟加拉裔与英国白人相比外，所有种族群体的覆盖率仍显著较低。
在考虑地理位置和贫困因素后，带状疱疹疫苗接种覆盖率因种族而异。英国白人、印度裔和孟加拉裔群体的覆盖率最高；混血：白人和非洲黑人以及其他黑人种族的覆盖率最低。患者的种族和IMD是覆盖率的预测因素，它们对地理差异覆盖率有影响，但不能完全解释这种差异。需要采取干预措施来解决带状疱疹疫苗接种覆盖率方面与服务相关、社会人口学和种族不平等问题。
