Imperial College London, Praed Street, London, UK.
London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.
Int J Equity Health. 2022 Jun 11;21(1):82. doi: 10.1186/s12939-022-01678-5.
Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies.
A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic.
One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest.
We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic.
Prospero, CRD42021261927.
现有证据表明，健康不平等，尤其是疫苗接种覆盖率的不平等，会对更广泛的社会产生影响。然而，尽管个别研究试图在国家层面上描述免疫接种覆盖率的这些异质性，但很少有研究从广泛和定量的角度来研究导致免疫接种覆盖率和效果异质性的因素，即避免的病例、死亡和伤残调整生命年的数量。本系统评价旨在通过定性和定量的方法来突出这些地理、人口和社会人口统计学特征，这对于优先考虑和优化疫苗接种政策至关重要。
使用搜索词和关键词对两个数据库（PubMed 和 Web of Science）进行了系统评价，以确定研究免疫不平等和疫苗接种覆盖率异质性因素的研究。两名研究人员独立应用纳入标准。对包括感兴趣的关键特征数据的研究进行了进一步分析，通过随机效应模型对该特征进行荟萃分析，得出风险比的汇总估计。
本综述共纳入 108 项研究。我们发现，财富、教育和地理获得方面的不平等会影响疫苗的效果和疫苗接种的中断。我们估计，与城市地区相比，生活在农村地区的人在完全接种疫苗方面没有显著差异，但各国之间存在相当大的异质性。我们发现，女性完全接种疫苗的比例比男性低 3%（95%CI[1%，5%]）。此外，我们估计，母亲没有接受过正规教育的儿童完全接种疫苗的可能性比母亲接受过小学或以上教育的儿童低 28%（95%CI[18%，47%]）。最后，我们发现，最贫困的五分之一人口完全接种疫苗的可能性比最富裕的五分之一人口低 27%（95%CI[16%，37%]）。
我们发现，疫苗接种覆盖率和获得方面存在细微的不平等现象，贫富差距是主要驱动因素，也可能导致其他不平等现象。本综述突出了不平等现象的复杂情况，进一步需要设计针对错过的亚组的疫苗接种策略，以在 COVID-19 大流行后提高和恢复疫苗接种覆盖率。
Prospero，CRD42021261927。
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