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使用改进指数评估旧金山湾区公平的COVID-19疫苗分配情况。

Use of the Improvement Index to Evaluate Equitable COVID-19 Vaccine Allocation in the San Francisco Bay Area.

作者信息

Jumamil Riana B, Rutherford George

机构信息

Department of Medicine, University of California San Francisco, San Francisco, California.

Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California.

出版信息

AJPM Focus. 2023 Jun;2(2):100075. doi: 10.1016/j.focus.2023.100075. Epub 2023 Feb 4.

Abstract

INTRODUCTION

A social determinants of health index score or Vaccine Equity Metric was used to prioritize resources and address geographic disparities in California's vaccination coverage. We calculated the improvement index or percentage of the vaccination disparity gap closed to evaluate the impacts of this vaccination strategy in the San Francisco Bay Area during the SARS-CoV-2 Delta variant surge.

METHODS

We conducted a cross-sectional study on San Francisco Bay Area ZIP codes during the Delta surge (July 6-October 5, 2021). Data came from the California Immunization Registry and the 2019 5-year American Community Survey. We used Spearman correlations to examine the relationships between Vaccine Equity Metric category and vaccine coverage and Kruskal-Wallis tests to compare vaccination improvement index across Vaccine Equity Metric categories.

RESULTS

We studied 248 ZIP codes in the San Francisco Bay Area. Those with the lowest resources (Vaccine Equity Metric Level 1) had the highest absolute increase in vaccination coverage (14.3 vs 5.4 percentage points in Vaccine Equity Metric Level 4), although a contribution was higher starting vaccination rates in Level 4 ZIP codes with the greatest resources. The ratio of vaccination coverage between the lowest- and highest-resourced ZIP codes increased from 0.79 to 0.9, suggesting reduced disparity. However, it is difficult to interpret given wide differences in (Level 1 =8 vs Level 4 =151). In contrast, the vaccination improvement index accounts for each Vaccine Equity Metric category's baseline vaccination; all were statistically similar (grand mean=41.5%, =0.367), implying comparable improvement across all ZIP codes.

CONCLUSIONS

Using a Vaccine Equity Metric to identify and prioritize resources to vulnerable communities contributed to equitable vaccine allocation in the San Francisco Bay Area. Our study shows an example of the improvement index's advantages over conventional health equity metrics, such as absolute differences and relative effect measures, which can overestimate an intervention's impact.

摘要

引言

使用健康指数得分的社会决定因素或疫苗公平指标来确定资源的优先次序,并解决加利福尼亚州疫苗接种覆盖率的地理差异问题。我们计算了改善指数或疫苗接种差距缩小的百分比,以评估在严重急性呼吸综合征冠状病毒2(SARS-CoV-2)德尔塔变异株激增期间,这一疫苗接种策略对旧金山湾区的影响。

方法

我们在德尔塔变异株激增期间(2021年7月6日至10月5日)对旧金山湾区的邮政编码区域进行了一项横断面研究。数据来自加利福尼亚州免疫登记处和2019年美国社区五年调查。我们使用斯皮尔曼相关性分析来检验疫苗公平指标类别与疫苗接种覆盖率之间的关系,并使用克鲁斯卡尔-沃利斯检验来比较不同疫苗公平指标类别的疫苗接种改善指数。

结果

我们研究了旧金山湾区的248个邮政编码区域。资源最少的地区(疫苗公平指标第1级)疫苗接种覆盖率的绝对增幅最高(14.3个百分点,而疫苗公平指标第4级为5.4个百分点),尽管资源最丰富的第4级邮政编码区域的起始接种率较高,这一因素的贡献更大。资源最少和资源最丰富的邮政编码区域之间的疫苗接种覆盖率之比从0.79提高到了0.9,这表明差距有所缩小。然而,鉴于(第1级=8,第4级=151)存在较大差异,难以对此进行解读。相比之下,疫苗接种改善指数考虑了每个疫苗公平指标类别的基线疫苗接种情况;所有类别在统计学上相似(总体均值=41.5%,P=0.367),这意味着所有邮政编码区域的改善情况相当。

结论

使用疫苗公平指标来识别资源并将其优先分配给弱势群体,有助于在旧金山湾区实现公平的疫苗分配。我们的研究展示了改善指数相对于传统健康公平指标(如绝对差异和相对效应量)的优势,传统指标可能会高估干预措施的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/76f9/10546496/1d7727747af1/ga1.jpg

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