Bolongaita Sarah, Villano Dominick, Memirie Solomon Tessema, Mirutse Mizan Kiros, Mirkuzie Alemnesh H, Comas Sophia, Rumpler Eva, Wu Stephanie M, Sato Ryoko, Chang Angela Y, Verguet Stéphane
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
Addis Center for Ethics and Priority Setting, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
PLOS Glob Public Health. 2022;2(8). doi: 10.1371/journal.pgph.0000819. Epub 2022 Aug 31.
Immunization is one of the most effective public health interventions, saving millions of lives every year. Ethiopia has seen gradual improvements in immunization coverage and access to child health care services; however, inequalities in child mortality across wealth quintiles and regions remain persistent. We model the relative distributional incidence and mortality of four vaccine-preventable diseases (VPDs) (rotavirus diarrhea, human papillomavirus, measles, and pneumonia) by wealth quintile and geographic region in Ethiopia. Our approach significantly extends an earlier methodology, which utilizes the population attributable fraction and differences in the prevalence of risk and prognostic factors by population subgroup to estimate the relative distribution of VPD incidence and mortality. We use a linear system of equations to estimate the joint distribution of risk and prognostic factors in population subgroups, treating each possible combination of risk or prognostic factors as computationally distinct, thereby allowing us to account for individuals with multiple risk factors. Across all modeling scenarios, our analysis found that the poor and those living in rural and primarily pastoralist or agrarian regions have a greater risk than the rich and those living in urban regions of becoming infected with or dying from a VPD. While in absolute terms all population subgroups benefit from health interventions (e.g., vaccination and treatment), current unequal levels and pro-rich gradients of vaccination and treatment-seeking patterns should be redressed so to significantly improve health equity across wealth quintiles and geographic regions in Ethiopia.
免疫接种是最有效的公共卫生干预措施之一，每年挽救数百万人的生命。埃塞俄比亚在免疫接种覆盖率和儿童医疗服务可及性方面已逐步改善；然而，不同财富五分位数群体和不同地区之间儿童死亡率的不平等现象依然存在。我们对埃塞俄比亚四种疫苗可预防疾病（轮状病毒腹泻、人乳头瘤病毒、麻疹和肺炎）按财富五分位数和地理区域的相对分布发病率及死亡率进行了建模。我们的方法显著扩展了早期的方法，早期方法利用人群归因分数以及不同人群亚组中风险因素和预后因素患病率的差异来估计疫苗可预防疾病发病率和死亡率的相对分布。我们使用线性方程组来估计人群亚组中风险因素和预后因素的联合分布，将风险因素或预后因素的每种可能组合视为在计算上不同，从而使我们能够考虑具有多种风险因素的个体。在所有建模情景中，我们的分析发现，与富裕人群和城市地区居民相比，贫困人群以及生活在农村且主要从事畜牧业或农业地区的居民感染疫苗可预防疾病或死于该疾病的风险更高。虽然从绝对意义上讲，所有人群亚组都能从健康干预措施（如疫苗接种和治疗）中受益，但目前疫苗接种和寻求治疗模式存在不平等水平且有利于富裕人群的梯度差异，应予以纠正，以便显著改善埃塞俄比亚不同财富五分位数群体和地理区域之间的健康公平性。
