Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain.
Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Granada, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
Semergen. 2022 Mar;48(2):96-105. doi: 10.1016/j.semerg.2021.10.008. Epub 2022 Jan 31.
Migrants, a population vulnerable to communicable diseases, face multiple barriers in access to immunization programs. Individual studies suggest that they suffer immunization inequity compared to non-migrants, but the gap in vaccination has not been quantified. This systematic review assessed quantitatively the level of vaccination coverage among migrants, in comparison with non-migrants, collating the published literature.
Review protocol was prospectively registered (PROSPERO CRD42021228061). A literature search without language restrictions was conducted in PubMed, Scopus and Web of Science, from database inception to February 2021. This review included observational studies that provided the vaccination rates among migrant and non-migrant groups. Study quality was assessed using Newcastle-Ottawa scale. Data were synthesized pooling data from individual studies to generate summary odds ratio (OR) with 95% confidence interval (CI) using random effects model, assessing heterogeneity with I statistic and publication bias with funnel asymmetry analysis.
There were 44 relevant studies (7,937,996 participants). Overall risk of bias was low in 13 (30%), moderate in 22 (50%) and high in 9 (20%) studies. Point estimates of individual ORs showed lower vaccination coverage among migrants in 36 of 39 meta-analyzable studies. Overall, the odds of vaccination coverage among migrants were lower compared to non-migrants (7,375,184 participants; summary OR 0.50; 95% CI 0.37-0.66; I 99.9%). There was no funnel asymmetry.
Migrants are half as often vaccinated compared to non-migrants. Public health prevention programs need to prioritize vaccination equity, not just to protect migrants but also to protect the host communities.
移民是易感染传染病的人群，他们在获得免疫规划方面面临多种障碍。个别研究表明，与非移民相比，他们在免疫方面存在不平等，但尚未量化疫苗接种方面的差距。本系统评价通过汇集已发表的文献，定量评估移民与非移民之间的疫苗接种覆盖率，以评估移民在获得免疫规划方面面临的障碍。
本综述方案预先进行了注册（PROSPERO CRD42021228061）。从数据库建立之初到 2021 年 2 月，我们在 PubMed、Scopus 和 Web of Science 上进行了无语言限制的文献检索。本综述纳入了提供移民和非移民群体疫苗接种率的观察性研究。使用纽卡斯尔-渥太华量表评估研究质量。使用随机效应模型汇总来自个体研究的数据，生成汇总优势比（OR）及其 95%置信区间（CI），用 I 统计量评估异质性，用漏斗图不对称分析评估发表偏倚。
共纳入 44 项相关研究（7937996 名参与者）。13 项（30%）研究的总体偏倚风险较低，22 项（50%）研究的偏倚风险为中度，9 项（20%）研究的偏倚风险较高。39 项可进行 meta 分析的研究中，有 36 项研究的个体 OR 点估计值表明移民的疫苗接种率较低。总体而言，与非移民相比，移民的疫苗接种覆盖率较低（7375184 名参与者；汇总 OR 0.50；95%CI 0.37-0.66；I 99.9%）。漏斗图无不对称性。
移民接种疫苗的比例是非移民的一半。公共卫生预防规划需要优先考虑疫苗接种公平性，不仅要保护移民，还要保护宿主社区。
