Cata-Preta Bianca de O, Wehrmeister Fernando C, Santos Thiago M, Barros Aluísio J D, Victora Cesar G
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
Am J Prev Med. 2021 Jan;60(1 Suppl 1):S24-S33. doi: 10.1016/j.amepre.2020.07.028. Epub 2020 Oct 29.
Coverage of health interventions usually shows social gradients with higher levels among wealthy than among poor individuals. Owing to the upsurge of vaccine hesitancy in high-income countries, the authors hypothesized that the social gradient may also be changing over time in the low- and middle-income countries and set out to test this hypothesis.
In January 2020, surveys conducted from 2010 to 2018 in 86 low- and middle-income countries were analyzed to assess full immunization coverage in children aged 12-23 months. The authors calculated full immunization coverage point estimates and 95% CIs for each country and wealth quintile. To explore wealth-related inequalities, the authors estimated the slope index of inequality and calculated the Pearson correlation coefficient between these values and per capita gross domestic product. Time trends were analyzed in 10 countries with recent evidence of hesitancy.
Pro-poor patterns were defined as significant slope index of inequality values with higher coverage among poor children, and pro-rich patterns were defined as the reverse pattern. A total of 11 countries showed pro-poor patterns in the most recent survey, accounting for 20% of upper middle- and 7% of low-income countries. The correlation between the slope index of inequality and log per capita gross domestic product was -0.38 (p<0.001). Among the 10 countries with recent evidence of hesitancy, 5 showed full immunization coverage declines over time in the wealthiest quintiles, and 4 switched from pro-rich to pro-poor patterns throughout the years.
Lower full immunization coverage was found among the wealthy than among the poor in 10 countries, especially in the upper middle-income group, consistent with the emergence of vaccine hesitancy.
This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
健康干预措施的覆盖情况通常呈现出社会梯度，富裕人群中的覆盖水平高于贫困人群。由于高收入国家疫苗犹豫情绪激增，作者推测低收入和中等收入国家的社会梯度可能也会随时间变化，因此着手检验这一假设。
2020年1月，对2010年至2018年在86个低收入和中等收入国家进行的调查进行分析，以评估12至23个月龄儿童的全程免疫覆盖率。作者计算了每个国家和财富五分位数的全程免疫覆盖率点估计值和95%置信区间。为探讨与财富相关的不平等现象，作者估计了不平等斜率指数，并计算了这些值与人均国内生产总值之间的皮尔逊相关系数。对10个近期有犹豫证据的国家的时间趋势进行了分析。
有利于穷人的模式被定义为不平等斜率指数值显著，贫困儿童的覆盖率更高；有利于富人的模式则被定义为相反的模式。在最近的调查中，共有11个国家呈现有利于穷人的模式，占中高收入国家的20%，低收入国家的7%。不平等斜率指数与人均国内生产总值对数之间的相关性为-0.38（p<0.001）。在10个近期有犹豫证据的国家中，5个国家最富裕五分位数人群的全程免疫覆盖率随时间下降，4个国家多年来从有利于富人的模式转变为有利于穷人的模式。
在10个国家中，富裕人群的全程免疫覆盖率低于贫困人群，尤其是在中高收入群体中，这与疫苗犹豫情绪的出现一致。
本文是题为《全球疫苗接种公平性》的增刊的一部分，该增刊由密歇根大学公共卫生学院全球疫苗公平研究所赞助。
