Rutgers School of Public Health, Department of Biostatistics and Epidemiology Piscataway, NJ, USA; Rutgers University, Ernest Mario School of Pharmacy, Piscataway, NJ, USA; Rutgers Robert Wood Johnson Medical School, Division of Infectious Diseases, New Brunswick, NJ, USA.
Rutgers School of Public Health, Department of Biostatistics and Epidemiology Piscataway, NJ, USA; Rutgers Robert Wood Johnson Medical School, Division of Gastroenterology and Hepatology, New Brunswick, NJ, USA.
Vaccine. 2019 Jul 9;37(30):4111-4117. doi: 10.1016/j.vaccine.2019.05.071. Epub 2019 Jun 10.
While the hepatitis A virus (HAV) vaccine is recommended for United States (US) travelers to endemic regions, vaccination rates are lower among non-US-born adults and some racial minority groups.
We aimed to examine the relationship between birthplace, race and their interaction as predictors of self-reported HAV vaccination among adult travelers to high-risk countries (HRCs) through analysis of the National Health Interview Survey (NHIS), 2012-2015.
The study included 36,872 US adult participants in the 2012-2015 NHIS who traveled to countries where HAV is endemic. The main outcome was self-reported HAV vaccination (≥2 doses). Complex survey methods were applied to all models to provide statistical estimates that were representative of US adults. Multivariable logistic regression models adjusting for demographic, socioeconomic, medical, and access-to-care characteristics were fitted to examine the association between birthplace, race, race-by-birthplace (for interaction) and vaccination status.
For adult travelers to HRCs, the adjusted odds ratio (AOR) of HAV vaccination was lower for non-US-born compared to US-born adults, AOR 0.86 (95% CI; 0.76, 0.98). For Hispanics, the AOR of HAV vaccination was 0.80 (95% CI; 0.70, 0.91) as compared to non-Hispanic-Whites. Furthermore, a significant qualitative interaction between birthplace and race was found (P-value 0.0005). Among non-Hispanic Blacks, the adjusted odds of HAV vaccination for non-US-born adults were 1.35 (95% CI; 1.06, 1.72) times the odds for US-born adults. In contrast, the AORs of HAV vaccination of non-US-born versus US-born adults were 36% (95% CI; 17%, 51%) and 30% (95% CI; 12%, 44%), lower for Asians and Hispanics, respectively.
The association between birthplace and HAV vaccination status differs by race among travelers to HRCs, with US-born non-Hispanic Black and non-US-born Asian and Hispanic adults having lower odds of vaccination. Health care resources should be focused on these target populations to improve travel vaccination compliance.
甲型肝炎病毒（HAV）疫苗已被推荐用于前往流行地区的美国（US）旅行者，但非美国出生的成年人和一些少数族裔群体的疫苗接种率较低。
我们旨在通过分析 2012-2015 年全国健康访谈调查（NHIS），研究出生地、种族及其相互作用作为前往高危国家（HRC）的成年旅行者自我报告 HAV 疫苗接种的预测因子之间的关系。
本研究纳入了 2012-2015 年 NHIS 中 36872 名前往甲型肝炎流行地区的美国成年旅行者，主要结局为自我报告的 HAV 疫苗接种（≥2 剂）。采用复杂的调查方法对所有模型进行分析，以提供具有代表性的美国成年人的统计估计值。调整人口统计学、社会经济、医疗和获得医疗保健特征的多变量逻辑回归模型用于检验出生地、种族、种族与出生地的相互作用（用于交互作用）与接种状况之间的关系。
对于前往 HRC 的成年旅行者，与美国出生的成年人相比，非美国出生的成年人的 HAV 疫苗接种调整后优势比（AOR）较低，AOR 为 0.86（95%CI；0.76，0.98）。与非西班牙裔白人相比，西班牙裔的 HAV 疫苗接种 AOR 为 0.80（95%CI；0.70，0.91）。此外，发现出生地和种族之间存在显著的定性交互作用（P 值<0.0005）。对于非西班牙裔黑人，非美国出生的成年人接种 HAV 的调整优势比是美国出生成年人的 1.35 倍（95%CI；1.06，1.72）。相比之下，非美国出生的成年人与美国出生的成年人相比，亚洲人和西班牙裔的 HAV 疫苗接种 AOR 分别降低了 36%（95%CI；17%，51%）和 30%（95%CI；12%，44%）。
在前往 HRC 的旅行者中，出生地和 HAV 疫苗接种状况之间的关联因种族而异，非美国出生的非西班牙裔黑人以及美国出生的亚洲人和西班牙裔成年人接种疫苗的几率较低。卫生保健资源应重点关注这些目标人群，以提高旅行疫苗接种的依从性。
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