Health Science Department, University of The People, Pasadena, CA, USA.
Online Research Club, Nagasaki, Japan.
BMC Infect Dis. 2023 Dec 15;23(1):880. doi: 10.1186/s12879-023-08878-6.
COVID-19 has caused millions of deaths globally, with vulnerable populations such as people experiencing homelessness (PEH) at higher risk. This systematic review and meta-analysis aims to identify the prevalence and key factors contributing to vaccine acceptance experienced by PEH.
The protocol of this study was registered in PROSPERO (CRD42023391659). We included studies that reported relevant information about vaccine acceptance or vaccine hesitant/refusal among PEH. Eight databases were systematically searched in January 2023. Meta-analysis was conducted for the prevalence of vaccine acceptance, vaccine uptake, and factors associated with vaccine acceptance. Attitudes toward vaccines were combined into bar charts.
A total of 29 papers were included in this systematic review and 19 papers were included for meta-analysis. The pooled prevalence of COVID-19 vaccine acceptance among PEH was 66% (95%CI: 58%-73%). Our meta-regression showed vaccine acceptance was significantly increased over time. Moreover, subgroup meta-analysis showed that PEH were more likely to accept the COVID-19 vaccine after June 2021 (78%, 95%CI: 65%-86%) compared with earlier period (56%, 95%CI: 54%-59%). Subgroup meta-analysis also revealed that women and participants without underlying medical condition (chronic diseases) were significantly less likely to accept the COVID-19 vaccine, compared to men and those with medical conditions, respectively.
The study emphasizes the need for targeted public health interventions aimed at increasing vaccine acceptance among PEH, especially at the early stage of the pandemic, among females, those without underlying medical conditions, being Black (in Canada and the USA), and young people. These interventions should address the common concerns of vaccine safety, adverse effects, effectiveness, and distrust in health care systems. In addition to offering vaccinations in different areas convenient to them, education programs could be established to increase vaccine acceptance among PEH.
COVID-19 在全球范围内已导致数百万人死亡，无家可归者等弱势群体面临更高的风险。本系统评价和荟萃分析旨在确定无家可归者（PEH）疫苗接种接受度的流行率和主要影响因素。
本研究方案已在 PROSPERO（CRD42023391659）中注册。我们纳入了报告有关 PEH 疫苗接种接受度或疫苗犹豫/拒绝相关信息的研究。2023 年 1 月系统地检索了 8 个数据库。对疫苗接受度、疫苗接种率以及与疫苗接受度相关的因素进行荟萃分析。疫苗态度被合并到条形图中。
本系统评价共纳入 29 篇论文，其中 19 篇进行荟萃分析。PEH 中 COVID-19 疫苗接受度的汇总流行率为 66%（95%CI：58%-73%）。我们的元回归显示，疫苗接受度随时间显著增加。此外，亚组荟萃分析表明，与早期相比，2021 年 6 月后（78%，95%CI：65%-86%）PEH 更有可能接受 COVID-19 疫苗（56%，95%CI：54%-59%）。亚组荟萃分析还表明，与男性和有基础疾病（慢性病）的参与者相比，女性和无基础疾病的参与者接受 COVID-19 疫苗的可能性显著降低。
本研究强调需要针对 PEH 开展有针对性的公共卫生干预措施，以提高疫苗接种接受度，尤其是在大流行早期、女性、无基础疾病、非裔（在加拿大和美国）和年轻人中。这些干预措施应解决疫苗安全性、不良反应、有效性和对医疗保健系统的不信任等常见问题。除了在他们方便的不同地区提供疫苗接种外，还可以建立教育计划来提高 PEH 的疫苗接种接受度。
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