Nandi Arindam, Kumar Santosh, Shet Anita, Bloom David E, Laxminarayan Ramanan
Center for Disease Dynamics, Economics & Policy, 1400 Eye St. NW, Suite 500, Washington, DC, 20005, USA.
Department of Economics and International Business, College of Business Administration, Sam Houston State University, SHB 237F, Huntsville, TX, 77340, USA.
Soc Sci Med. 2020 Feb 26;250:112885. doi: 10.1016/j.socscimed.2020.112885.
Routine childhood vaccines are among the most cost-effective life-saving interventions. In addition, vaccines have been linked with reduced stunting and improved health and other outcomes in later life. However, evidence on such long-term benefits remain inadequate. In this study, we examined the associations between the initiation and implementation of the Universal Immunization Programme (UIP) in India and schooling attainment among adults. We obtained district-level data on the rollout of the UIP in 1985-1990 and matched those with data from the National Family Health Survey of India, 2015-2016. Adults who were born in the five years before and after the rollout period (1980-1995) and always lived in the same location were included in the analysis (n=109,908). We employed household, village or city ward, district, and state fixed-effects linear regression models, which incorporated a wide range of socioeconomic and demographic indicators and community-level infrastructure, amenities, and access to healthcare. We compared schooling attainment in years among individuals who were born during or after the UIP was implemented in their districts (intervention group) with those who were born before UIP implementation (control group). In household fixed-effects analysis, intervention group adults attained 0.18 (95% confidence interval [CI]: 0.02, 0.33; p<0.05) more schooling grades as compared with control group adults from the same household. In village or city ward, district, and state fixed-effects analysis, intervention group adults attained 0.23 (95% CI: 0.13, 0.32; p<0.001), 0.29 (95% CI: 0.19, 0.38; p<0.001), and 0.25 (95% CI: 0.1, 0.39; p<0.01) additional schooling grades, respectively, compared to the control group. In subgroup analyses, positive associations between UIP implementation and schooling grades were observed among women and among rural, urban, and richer households. Our results support the association of vaccines with improved school attainment.
常规儿童疫苗是最具成本效益的挽救生命的干预措施之一。此外，疫苗与减少发育迟缓以及改善晚年健康和其他结果有关。然而，关于此类长期益处的证据仍然不足。在本研究中，我们考察了印度通用免疫计划（UIP）的启动和实施与成年人受教育程度之间的关联。我们获取了1985 - 1990年UIP推广的地区层面数据，并将其与2015 - 2016年印度全国家庭健康调查的数据进行匹配。分析纳入了在推广期前后五年（1980 - 1995年）出生且一直居住在同一地点的成年人（n = 109,908）。我们采用了家庭、村庄或城市街区、地区和州固定效应线性回归模型，这些模型纳入了广泛的社会经济和人口指标以及社区层面的基础设施、便利设施和医疗保健可及性。我们比较了在其所在地区实施UIP期间或之后出生的个体（干预组）与在UIP实施之前出生的个体（对照组）的受教育年限。在家庭固定效应分析中，与来自同一家庭的对照组成年人相比，干预组成年人的受教育年级多0.18（95%置信区间[CI]：0.02，0.33；p<0.05）。在村庄或城市街区、地区和州固定效应分析中，与对照组相比，干预组成年人分别多获得0.23（95%CI：0.13，0.32；p<0.001）、0.29（95%CI：0.19，0.38；p<0.001）和0.25（95%CI：0.1，0.39；p<0.01）个受教育年级。在亚组分析中，在女性以及农村、城市和较富裕家庭中观察到UIP实施与受教育年级之间存在正相关。我们的结果支持疫苗与提高学业成绩之间的关联。
