UOC Epidemiology Unit, Agency for Health Protection of the Metropolitan Area of Milan (Italy);
UOC Epidemiology Unit, Agency for Health Protection of the Metropolitan Area of Milan (Italy).
Epidemiol Prev. 2021;45(6):568-579. doi: 10.19191/EP21.6.114.
to present an evaluation of the campaign for vaccination against COVID-19 in the territory covered by the Agency for Health Protection of the Metropolitan Area of Milan from 01.01.2021 to 30.09.2021.
descriptive study of vaccine adherence; predictive study of the factors associated with vaccine adherence, efficacy of vaccination in terms of hospitalization and mortality, and factors that increase the risk of hospital admission following full vaccination.
population-based study with subjects aged >18 years eligible for vaccination (N. 2,981,997). An information system obtained by integrating various administrative healthcare sources made it possible to analyse socioeconomic characteristics, COVID-19 related hospitalizations, and general mortality in subjects eligible for vaccination.
full vaccination (2 doses); COVID-19-related hospitalizations, COVID-19-related hospitalizations occurring more than 15 days after the second dose, general mortality.
in the first nine months of the vaccination campaign, 74.7% of the subjects (N. 2,228,915) was fully vaccinated, whereas 15.6% (N. 465,829) did not even receive one dose. Women have a lower probability of getting vaccinated than men; the 50-59 years and 70+ years age groups emerge as the most problematic to reach, while the younger one (<40) is the most adherent. A social gradient emerged, with residents of more disadvantaged areas progressively less incline to get vaccinated than those living in more affluent areas. Adherence is greater in Italian citizenship and is likely to increase with an increase in the number of chronic conditions. Hospitalizations amounted to 1.22% (N. 5,672) in the unvaccinated population compared to 0.05% (N. 1,013) in the vaccinated population; general mortality was 4.51% (N. 15,198) in the unvaccinated population against 0.32% (N. 8.733) in the vaccinated population. Sociodemographic factors and the presence of previous health conditions are important predictors of hospitalization outcomes even within the fully vaccinated population. Specifically, the highest hazard ratios are found in subjects with heart failure (HR 2.15; 95%CI 1.83-2.53), in immunocompromised patients (HR 2.02; 95%CI 1.52-2.69), and in transplant recipients (HR 1.92; 95%CI 1.10-3.33).
vaccination campaign adherence is affected by the sociodemographic characteristics of the population and is a determining factor in preventing hospitalizations for COVID-19 and death. The persistent higher risk of hospitalization in chronic subjects following the second dose emphasizes the need to direct booster doses to the more vulnerable. Information systems proved to be effective monitoring tools in the absence of specific trials.
评估米兰大都市区卫生局辖区内 2021 年 1 月 1 日至 2021 年 9 月 30 日期间针对 COVID-19 的疫苗接种运动。
疫苗接种依从性描述性研究；与疫苗接种依从性相关的因素预测研究、疫苗接种对住院和死亡率的疗效、以及完全接种疫苗后住院风险增加的因素。
基于人群的研究，研究对象为年龄>18 岁、有资格接种疫苗的人群（N. 2,981,997）。一个通过整合各种行政医疗保健资源获得的信息系统使分析有资格接种疫苗的人群的社会经济特征、与 COVID-19 相关的住院治疗和一般死亡率成为可能。
完全接种（2 剂）；与 COVID-19 相关的住院治疗，第二剂后超过 15 天发生的与 COVID-19 相关的住院治疗，一般死亡率。
在疫苗接种运动的头九个月，74.7%的研究对象（N. 2,228,915）完全接种了疫苗，而 15.6%（N. 465,829）甚至没有接种一剂。女性接种疫苗的可能性低于男性；50-59 岁和 70+岁年龄组是最难达到的，而年龄较小的（<40 岁）是最依从的。出现了社会阶层分化，居住在较不利地区的居民接种疫苗的意愿低于居住在较富裕地区的居民。意大利公民的接种率较高，并且随着慢性疾病数量的增加而可能增加。未接种疫苗的人群中住院率为 1.22%（N. 5,672），而接种疫苗的人群中住院率为 0.05%（N. 1,013）；未接种疫苗的人群总死亡率为 4.51%（N. 15,198），而接种疫苗的人群总死亡率为 0.32%（N. 8.733）。社会人口统计学因素和以前的健康状况是住院结局的重要预测因素，即使在完全接种疫苗的人群中也是如此。具体来说，心力衰竭患者（HR 2.15；95%CI 1.83-2.53）、免疫功能低下患者（HR 2.02；95%CI 1.52-2.69）和移植受者（HR 1.92；95%CI 1.10-3.33）的风险比最高。
疫苗接种运动的依从性受人口的社会人口特征影响，是预防 COVID-19 住院和死亡的决定因素。第二剂后慢性患者住院风险持续升高，强调需要向更脆弱的人群提供加强剂量。信息系统在没有特定试验的情况下被证明是有效的监测工具。
