Fabiani Massimo, Ferrante Gianluigi, Minardi Valentina, Giambi Cristina, Riccardo Flavia, Declich Silvia, Masocco Maria
National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Italian National Institute of Health (ISS), Rome, Italy.
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
PLoS One. 2017 Oct 2;12(10):e0178122. doi: 10.1371/journal.pone.0178122. eCollection 2017.
International migration rapidly increased in the last decade, raising a renewed attention to its impact on public health. We evaluated differences in rubella immunization rate (RIR) between immigrant and Italian women of childbearing age and tried to identify the driving factors causing them.
We analyzed data from the Italian behavioral surveillance system PASSI collected in 2011-2015 in a nationally representative sample of residents in Italy. The analysis was performed using log-binomial models to compare RIR between 41,094 Italian women and 3140 regular immigrant women of childbearing age (18-49 years), stratifying the latter by area of origin and length-of-stay in Italy (recent: ≤ 5-years; mid-term: 6-10-years; long-term: > 10-years).
Immigrant women showed a RIR of 36.0% compared to 60.2% among Italian women (RIR-ratio = 0.60, 95% confidence interval (CI): 0.57-0.63). Adjusting for demographic characteristics (i.e., sex, age and area of residence), socio-economic factors (i.e., education, occupation, family composition and economic status) and an indicator of the presence of at least one health-risk behavior (i.e., physical inactivity, current cigarette smoking, excessive alcohol consumption and excess weight) did not significantly change this difference (RIR-ratio = 0.56, 95% CI: 0.53-0.59). Recent immigrants (RIR-ratio = 0.47, 95% CI: 0.42-0.53) and immigrants from high migratory pressure countries (HMPC) in sub-Saharan Africa (RIR-ratio = 0.41, 95% CI: 0.31-0.56) and Asia (RIR-ratio = 0.42, 95% CI: 0.33-0.53) showed the greatest differences in RIR compared with Italian women.
Differences in RIR between immigrant and Italian women were not explained by different demographic, socioeconomic and health-risk behaviors characteristics. As entitlement to free-of-charge immunization in Italy is universal, regardless of migration status, other informal barriers (e.g., cultural and barriers to information access) might explain lower RIRs in immigrant women, especially recent immigrants and those from HMPC in sub-Saharan Africa and Asia. Further investigations are needed to identify obstacles and appropriate promotion and access-enabling strategies for rubella immunization.
在过去十年中，国际移民迅速增加，这再次引发了人们对其对公共卫生影响的关注。我们评估了育龄期移民妇女和意大利妇女之间风疹免疫率（RIR）的差异，并试图找出导致这些差异的驱动因素。
我们分析了2011 - 2015年从意大利行为监测系统PASSI收集的数据，该数据来自意大利全国具有代表性的居民样本。分析采用对数二项模型，比较41,094名意大利育龄妇女（18 - 49岁）和3140名正常育龄期移民妇女的RIR，并根据原籍地区和在意大利的停留时间（近期：≤5年；中期：6 - 10年；长期：>10年）对后者进行分层。
移民妇女的RIR为36.0%，而意大利妇女为60.2%（RIR比率 = 0.60，95%置信区间（CI）：0.57 - 0.63）。在调整了人口统计学特征（即性别、年龄和居住地区）、社会经济因素（即教育程度、职业、家庭构成和经济状况）以及至少一种健康风险行为指标（即身体活动不足、当前吸烟、过量饮酒和超重）后，这种差异没有显著变化（RIR比率 = 0.56，95% CI：0.53 - 0.59）。近期移民（RIR比率 = 0.47，95% CI：0.42 - 0.53）以及来自撒哈拉以南非洲（RIR比率 = 0.41，95% CI：0.31 - 0.56）和亚洲（RIR比率 = 0.42，95% CI：0.33 - 0.53）高移民压力国家（HMPC）的移民与意大利妇女相比，RIR差异最大。
移民妇女和意大利妇女之间RIR的差异不能用不同的人口统计学、社会经济和健康风险行为特征来解释。由于在意大利，无论移民身份如何，均可免费接种疫苗，因此其他非正式障碍（如文化和信息获取障碍）可能解释了移民妇女，尤其是近期移民以及来自撒哈拉以南非洲和亚洲HMPC的移民RIR较低的原因。需要进一步调查以确定风疹免疫接种的障碍以及适当的促进和便利获取策略。
