Federal University of Santa Catarina, Eng. Agronômico Andrei Cristian Ferreira Street, Florianópolis, SC 88040-900, Brazil.
University of Sao Paulo, 1280 Prof. Almeida Prado Avenue, São Paulo, SP 05508-070, Brazil.
Vaccine. 2023 Jun 13;41(26):3937-3945. doi: 10.1016/j.vaccine.2023.05.030. Epub 2023 May 17.
Vaccination is crucial for reducing severe COVID-19 cases, hospitalizations, and deaths. However, vaccine access disparities within countries, particularly in low- and middle-income nations, may leave disadvantaged regions and populations behind. This study aimed to investigate potential inequalities in vaccine coverage among Brazilian aged 18 years and older based on demographic, geographic, and socioeconomic characteristics at the municipal level. A total of 389 million vaccination records from the National Immunization Program Information System were analyzed to calculate vaccine coverage rates for the first, second, and booster doses among adults (18-59 years) and elderly (60 + years) vaccinated between January 2021 and December 2022. We analyzed the data by gender and used a three-level (municipalities, states, regions) multilevel regression analysis to assess the association between vaccine coverage and municipal characteristics. Vaccination coverage was higher among the elderly than among adults, particularly for the second and booster doses. Adult women showed higher coverage rates than men (ranging from 118 % to 25 % higher along the analyzed period). Significant inequalities were observed when analyzing the evolution of vaccination coverage by sociodemographic characteristics of municipalities. In the early stages of the vaccination campaign, municipalities with higher per capita Gross Domestic Product (pGDP), educational level, and fewer Black residents reached higher population coverages earlier. In December 2022, adult and elderly booster vaccine coverage was 43 % and 19 %, respectively, higher in municipalities in the highest quintile of educational level. Higher vaccine uptake was also observed in municipalities with fewer Black residents and higher pGDP. Municipalities accounted for most of the variance in vaccine coverage (59.7 %-90.4 % depending on the dose and age group). This study emphasizes the inadequate booster coverage and the presence of socioeconomic and demographic disparities in COVID-19 vaccination rates. These issues must be addressed through equitable interventions to avoid potential disparities in morbidity and mortality.
接种疫苗对于减少严重的 COVID-19 病例、住院和死亡至关重要。然而,国家内部的疫苗获取差距,特别是在低收入和中等收入国家,可能会使弱势地区和人群掉队。本研究旨在调查巴西 18 岁及以上人群的疫苗接种覆盖情况在人口统计学、地理和社会经济特征方面的潜在不平等。利用国家免疫计划信息系统的 3.89 亿份疫苗接种记录,分析了 2021 年 1 月至 2022 年 12 月期间接种的成年人(18-59 岁)和老年人(60 岁以上)的第一、第二和加强剂量的疫苗接种率。我们按性别分析了数据,并使用三级(市级、州级、地区级)多层回归分析来评估疫苗接种覆盖与市级特征之间的关联。老年人的疫苗接种率高于成年人,尤其是第二剂和加强剂。成年女性的接种率高于男性(分析期间的覆盖率高出 118%至 25%不等)。分析按市级社会人口特征演变的疫苗接种覆盖情况时,观察到了显著的不平等。在疫苗接种运动的早期,人均国内生产总值(pGDP)、教育水平较高且黑人群体较少的市级地区更早达到较高的人群覆盖率。2022 年 12 月,教育水平最高的五分之一市级地区的成年人和老年人加强疫苗接种率分别高出 43%和 19%。在黑人群体较少和 pGDP 较高的市级地区,疫苗接种率也较高。市级地区对疫苗接种覆盖率的变化贡献最大(取决于剂量和年龄组,占 59.7%-90.4%)。本研究强调了 COVID-19 加强剂接种覆盖率不足以及疫苗接种率存在社会经济和人口统计学差异的问题。必须通过公平干预来解决这些问题,以避免发病率和死亡率方面的潜在差异。
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