肝硬化患者的医疗质量：成人推荐疫苗接种覆盖率的趋势

Quality of Care in Patients With Cirrhosis: Trends in Recommended Adult Vaccination Coverage.

作者信息

Ahmmad Eimad M, Roberts Lewis R

机构信息

Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN.

出版信息

Mayo Clin Proc Innov Qual Outcomes. 2020 Sep 22;4(6):667-682. doi: 10.1016/j.mayocpiqo.2020.06.007. eCollection 2020 Dec.

OBJECTIVE

To assess the proportion of patients with cirrhosis up to date with vaccinations and associations of vaccination with age, sex, race, ethnicity, marital status, and type of provider follow-up.

PATIENTS AND METHODS

Patients with cirrhosis diagnosed at Mayo Clinic in Rochester and Mayo Clinic Health System in Minnesota from January 1, 2007, to December 31, 2009, were followed up from diagnosis until May 31, 2015. Data were abstracted from Mayo Clinic and Minnesota State records. Factors determining vaccination coverage were assessed.

RESULTS

At the end of the study period (8 years follow-up), 26.4% (95 of 360), 24.7% (82 of 332), 63.2% (180 of 285), and 25.5% (54 of 212) of patients with cirrhosis were up to date with hepatitis A virus (HAV), hepatitis B virus, pneumococcal pneumonia (PN), and herpes zoster vaccinations, respectively. Influenza (FLU) vaccine coverage increased from 36.1% (57 of 158) in 2007 to 2008 to 65.8% (106 of 161) in 2014 to 2015. Of those unvaccinated for HAV and hepatitis B virus before cirrhosis diagnosis, 18.6% (59 of 318) and 23.4% (71 of 304) completed vaccination. For HAV, more whites than nonwhites (28.3% [91 of 322] vs 10.5% [4 of 38]; odds ratio [OR], 3.35; 95% CI, 1.29 to 11.45; =.02) and more non-Hispanics than Hispanics (27.4% [95 of 347] vs 0% [0 of 13]; OR, 0.00; 95% CI, 0.00 to 0.43; =.03) were vaccinated. For PN, more younger than elderly people (66.8% [135 of 202] vs 54.2% [45 of 83]; OR, 1.70; 95% CI, 1.01 to 2.87; =.04) and married vs single people (56.8% [100 of 176] vs 73.4% [80 of 109]; OR, 2.10; 95% CI, 1.26 to 3.56; =.005) were vaccinated. For FLU, in 2013 to 2014, more elderly (72.0% [54 of 75] vs 58.0% [69 of 119]; OR, 0.54; 95% CI, 0.28 to 0.99; =.05); in 2008 to 2009, more Hispanics (100% [4 of 4] vs 41.6% [116 of 279]; OR, ∞; 95% CI, 2.25 to ∞; =.02); and in 2011 to 2012, more married people (62.4% [101 of 162] vs 50.5% [56 of 111]; OR, 1.63; 95% CI, 0.1.0 to 2.66; =.05) were vaccinated. For FLU in 2008 to 2009, coverage was higher in the primary care than the specialist setting (55.8% [48 of 86] vs 36.6% [72 of 197]; =.003).

CONCLUSION

Except for PN and FLU, vaccination coverage in patients with cirrhosis falls short of Healthy People 2020 target. Specific interventions are needed to improve vaccination coverage in patients with cirrhosis.

目的

评估肝硬化患者最新疫苗接种情况的比例，以及疫苗接种与年龄、性别、种族、民族、婚姻状况和医疗服务提供者随访类型之间的关联。

患者与方法

对2007年1月1日至2009年12月31日在罗切斯特梅奥诊所和明尼苏达州梅奥诊所医疗系统诊断为肝硬化的患者进行随访，从诊断开始直至2015年5月31日。数据从梅奥诊所和明尼苏达州的记录中提取。评估决定疫苗接种覆盖率的因素。

结果

在研究期结束时（8年随访），肝硬化患者中甲型肝炎病毒（HAV）、乙型肝炎病毒、肺炎球菌肺炎（PN）和带状疱疹疫苗接种最新的比例分别为26.4%（360例中的95例）、24.7%（332例中的82例）、63.2%（285例中的180例）和25.5%（212例中的54例）。流感（FLU）疫苗接种覆盖率从2007年至2008年的36.1%（158例中的57例）增加到2014年至2015年的65.8%（161例中的106例）。在肝硬化诊断前未接种HAV和乙型肝炎病毒疫苗的患者中，18.6%（318例中的59例）和23.4%（304例中的71例）完成了疫苗接种。对于HAV，接种疫苗的白人比非白人更多（28.3%[322例中的91例]对10.5%[38例中的4例]；优势比[OR]，3.35；95%置信区间[CI]，1.29至11.45；P = 0.02），非西班牙裔比西班牙裔更多（27.4%[347例中的95例]对0%[13例中的0例]；OR，0.00；95%CI，0.00至0.43；P = 0.03）。对于PN，较年轻的人比老年人接种疫苗的更多（66.8%[202例中的135例]对54.2%[83例中的45例]；OR，1.70；95%CI，1.01至2.87；P = 0.04），已婚者比单身者接种疫苗的更多（56.8%[176例中的100例]对73.4%[109例中的80例]；OR，2.10；95%CI，1.26至3.56；P = 0.005）。对于FLU，在2013年至2014年，老年人接种疫苗的更多（72.0%[75例中的54例]对58.0%[119例中的69例]；OR，0.54；95%CI，0.28至0.99；P = 0.05）；在2008年至2009年，西班牙裔接种疫苗的更多（100%[4例中的4例]对41.6%[279例中的116例]；OR，∞；95%CI，2.25至∞；P = 0.02）；在2011年至2012年，已婚者接种疫苗的更多（62.4%[162例中的101例]对50.5%[111例中的56例]；OR，1.63；95%CI，1.0至2.66；P = 0.05）。对于2008年至2009年的FLU，初级保健机构的接种覆盖率高于专科机构（55.8%[86例中的48例]对36.6%[197例中的72例]；P = 0.003）。