Tandy Corinne B, Odoi Agricola
Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, TN, United States.
PeerJ. 2022 Feb 22;10:e12973. doi: 10.7717/peerj.12973. eCollection 2022.
In the United States, state-level policies requiring vaccination of school-going children constitute a critical strategy for improving vaccination coverage. However, policies allowing vaccination exemptions have also been implemented and contribute to reductions in vaccination coverage and potential increases in the burden of vaccine-preventable diseases. Understanding the geographic disparities in the distribution of vaccination exemptions and identifying high risk areas is necessary for guiding resource allocation and public health control strategies. This study investigated geographic disparities in vaccination exemptions as well as socioeconomic and demographic predictors of vaccination exemptions in Florida.
Vaccination exemption data were obtained from the Florida Department of Health's Florida HealthCHARTS web interface. Spatial patterns in geographic distribution of total and non-medical vaccination exemptions were assessed using county-level choropleth maps. Negative binomial models were used to identify significant predictors of county-level risks of both total and non-medical vaccination exemptions.
Total exemptions varied from 0 to 30.2 per 10,000 people. Nine counties had exemption risks in the top two classes (10.4-15.9 and 15.9-30.2 exemptions per 10,000 people). These counties were distributed in five distinct areas: Western Panhandle, central northern area, central, South-eastern coastal area, and the southern coastal border of the state. Non-medical exemptions varied from 0 to 10.4 per 10,000 people. Fifteen counties had exemption risks in the top two classes (3.7-5.6 and 5.6-10.4 exemptions per 10,000 people), and were located in six distinct areas: Western and Central Panhandle, Northeastern, Central-eastern coastal area, Central-western coastal area, and the South-western coastal border of the state. Predictors of high risk of total vaccination exemptions were high density of primary care providers ( < 0.001), high median income ( = 0.001), high percentage of Hispanic population ( = 0.046), and low percentage of population with a college education ( = 0.013). A predictor of high risk of non-medical vaccination exemptions was high percentage of White population ( = 0.045). However, predictors of low risks of non-medical exemptions were high percentages of population: living in rural areas ( = 0.023), with college education ( = 0.013), with high school education ( = 0.009), and with less than high school education ( < 0.001).
There is evidence of county-level geographic disparities in both total and non-medical vaccination exemption risks in Florida. These disparities are explained by differences in county-level socioeconomic and demographic factors. Study findings are important in guiding resource allocation for health planning aimed at improving vaccination rates and reducing incidence of vaccine-preventable diseases.
在美国，要求学龄儿童接种疫苗的州级政策是提高疫苗接种覆盖率的关键策略。然而，允许疫苗豁免的政策也已实施，这导致疫苗接种覆盖率下降，并可能增加疫苗可预防疾病的负担。了解疫苗豁免分布的地理差异并确定高风险地区对于指导资源分配和公共卫生控制策略至关重要。本研究调查了佛罗里达州疫苗豁免的地理差异以及疫苗豁免的社会经济和人口统计学预测因素。
从佛罗里达州卫生部的佛罗里达健康图表网络界面获取疫苗豁免数据。使用县级分级统计图评估总疫苗豁免和非医疗疫苗豁免地理分布的空间模式。采用负二项式模型确定县级总疫苗豁免和非医疗疫苗豁免风险的显著预测因素。
总豁免率从每万人0至30.2不等。九个县的豁免风险处于前两个等级（每万人10.4 - 15.9和15.9 - 30.2次豁免）。这些县分布在五个不同区域：西潘汉德尔地区、中北部地区、中部、东南沿海地区和该州南部沿海边境。非医疗豁免率从每万人0至10.4不等。十五个县的豁免风险处于前两个等级（每万人3.7 - 5.6和5.6 - 10.4次豁免），并位于六个不同区域：西和中潘汉德尔地区、东北部、中东部沿海地区、中西部沿海地区和该州西南部沿海边境。总疫苗豁免高风险的预测因素包括初级保健提供者密度高（<0.001）、收入中位数高（=0.001）、西班牙裔人口比例高（=0.046）以及大学教育人口比例低（=0.013）。非医疗疫苗豁免高风险的一个预测因素是白人人口比例高（=0.045）。然而，非医疗豁免低风险的预测因素包括以下人口比例高：居住在农村地区（=0.023）、拥有大学教育（=0.013）、拥有高中教育（=0.009）以及未接受高中教育（<0.001）。
有证据表明佛罗里达州在总疫苗豁免和非医疗疫苗豁免风险方面存在县级地理差异。这些差异可由县级社会经济和人口因素的差异来解释。研究结果对于指导旨在提高疫苗接种率和降低疫苗可预防疾病发病率的卫生规划资源分配具有重要意义。
