Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48103, USA.
Public Health. 2019 Feb;167:41-49. doi: 10.1016/j.puhe.2018.11.009. Epub 2019 Jan 9.
Using 542,159 vaccination records from children born between April 1, 2007, and March 31, 2012, in the Michigan Care Improvement Registry and data from the American Community Survey, we determine if neighbourhood-level characteristics at the Census tract level and block level are associated with low uptake of the fourth dose of diphtheria-tetanus-acellular pertussis vaccine (DTaP4).
This study was a cross-sectional study.
We used exploratory factor analysis to determine important socio-economic factors at the Census block level and tract level. We then used generalised estimating equations to test the relationship between block- and tract-level socio-economic factors and DTaP4 uptake.
DTaP4 coverage was 88.6% (95% confidence interval [CI]: 88.4%-88.7%) in Michigan. At the Census tract level, two factors surfaced as important for DTaP4 vaccination: 'affluence' (Cronbach's alpha = 0.88) and 'socio-economic disadvantage' (Cronbach's alpha = 0.89). At the Census block level, one factor was important: 'affluence' (Cronbach's alpha = 0.90). Affluence may relate to knowledge about medical exemptions and antivaccination sentiment, while socio-economic disadvantage may indicate limited access to healthcare resources. Children in high-affluence tracts had 1.08% lower vaccination coverage (95% CI: -1.62% to -0.55%) than children in low affluence tracts. Children in low socio-economic disadvantage tracts had 2.92% higher coverage than children in high socio-economic disadvantage tracts (95% CI: 2.58%-3.26%).
This study articulates the need to further understand the contribution of neighbourhood-level characteristics, from both affluent and socioeconomically disadvantaged areas to low vaccination rates. Developing a better understanding of these social environmental factors will help determine useful community-level interventions to improve vaccination rates and reduce disease burden.
利用密歇根州医疗改善注册中心 2007 年 4 月 1 日至 2012 年 3 月 31 日期间出生的 542159 名儿童的疫苗接种记录和美国社区调查数据，确定在普查地段和街区层面的邻里特征是否与白喉、破伤风、无细胞百日咳疫苗（DTaP4）第四剂接种率低有关。
本研究为横断面研究。
我们使用探索性因子分析确定普查块和普查区层面重要的社会经济因素。然后，我们使用广义估计方程检验街区和普查区社会经济因素与 DTaP4 接种率之间的关系。
密歇根州 DTaP4 接种率为 88.6%（95%置信区间：88.4%-88.7%）。在普查区层面，有两个因素对 DTaP4 疫苗接种很重要：“富裕”（Cronbach's alpha=0.88）和“社会经济劣势”（Cronbach's alpha=0.89）。在普查块层面，一个因素很重要：“富裕”（Cronbach's alpha=0.90）。富裕可能与对医疗豁免和反疫苗接种情绪的了解有关，而社会经济劣势可能表明获得医疗资源的机会有限。处于高富裕地段的儿童的接种率比处于低富裕地段的儿童低 1.08%（95%置信区间：-1.62%至-0.55%）。处于低社会经济劣势地段的儿童的接种率比处于高社会经济劣势地段的儿童高 2.92%（95%置信区间：2.58%-3.26%）。
本研究阐明了需要进一步了解来自富裕和社会经济劣势地区的邻里特征对低疫苗接种率的贡献。更好地了解这些社会环境因素将有助于确定有用的社区层面干预措施，以提高疫苗接种率并减轻疾病负担。
