Service de Rhumatologie, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
Rheumatology Department, School of Medicine, Universidad Cientifica del Sur, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.
Rheumatology (Oxford). 2021 Oct 9;60(SI):SI68-SI76. doi: 10.1093/rheumatology/keab432.
Given the COVID-19 pandemic, it is crucial to understand the underlying behavioural determinants of SARS-CoV-2 vaccine hesitancy in patients with autoimmune or inflammatory rheumatic diseases (AIIRDs). We aimed to analyse patterns of beliefs and intention regarding SARS-CoV-2 vaccination in AIIRD patients, as a mean of identifying pragmatic actions that could be taken to increase vaccine coverage in this population.
Data relating to 1258 AIIRD patients were analysed using univariate and multivariate logistic regression models, to identify variables associated independently with willingness to get vaccinated against SARS-CoV-2. Subsets of patients showing similar beliefs and intention about SARS-CoV-2 vaccination were characterized using cluster analysis.
Hierarchical cluster analysis identified three distinct clusters of AIIRD patients. Three predominant patient attitudes to SARS-COV-2 vaccination were identified: voluntary, hesitant and suspicious. While vaccine willingness differed significantly across the three clusters (P < 0.0001), there was no significant difference regarding fear of getting COVID-19 (P = 0.11), the presence of comorbidities (P = 0.23), the use of glucocorticoids (P = 0.21), or immunocompromised status (P = 0.63). However, patients from cluster #2 (hesitant) and #3 (suspicious) were significantly more concerned about vaccination, the use of a new vaccine technology, lack of long-term data in relation to COVID-19 vaccination, and potential financial links with pharmaceutical companies (P < 0.0001 in all) than patients from cluster #1 (voluntary).
Importantly, the differences between clusters in terms of patient beliefs and intention was not related to the fear of getting COVID-19 or to any state of frailty, but was related to specific concerns about vaccination. This study may serve as a basis for improved communication and thus help increase COVID-19 vaccine coverage among AIIRD patients.
鉴于 COVID-19 大流行，了解自身免疫或炎症性风湿病（AIIRD）患者对 SARS-CoV-2 疫苗犹豫不决的潜在行为决定因素至关重要。我们旨在分析 AIIRD 患者对 SARS-CoV-2 疫苗接种的信念和意图模式，以确定可在该人群中增加疫苗接种率的实用措施。
使用单变量和多变量逻辑回归模型分析了与 1258 名 AIIRD 患者相关的数据，以确定与愿意接种 SARS-CoV-2 疫苗相关的独立变量。使用聚类分析对具有相似 SARS-CoV-2 疫苗接种信念和意图的患者亚组进行了描述。
分层聚类分析确定了 AIIRD 患者的三个不同亚群。确定了三种主要的 SARS-COV-2 疫苗接种患者态度：自愿、犹豫和怀疑。虽然三个亚群的疫苗接种意愿差异显著（P < 0.0001），但对感染 COVID-19 的恐惧（P = 0.11）、合并症的存在（P = 0.23）、糖皮质激素的使用（P = 0.21）或免疫功能低下状态（P = 0.63）没有显著差异。然而，来自第 2 组（犹豫）和第 3 组（怀疑）的患者对疫苗接种、新疫苗技术的使用、缺乏与 COVID-19 疫苗接种相关的长期数据以及与制药公司的潜在财务联系更为关注（所有 P 值均<0.0001）比来自第 1 组（自愿）的患者。
重要的是，三个亚群之间在患者信念和意图方面的差异与对感染 COVID-19 的恐惧或任何脆弱状态无关，而是与对疫苗接种的具体担忧有关。这项研究可以为改善沟通提供依据，并有助于提高 AIIRD 患者的 COVID-19 疫苗接种率。
