Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana.
JAMA Netw Open. 2024 Aug 1;7(8):e2426847. doi: 10.1001/jamanetworkopen.2024.26847.
Seventeen states introduced COVID-19 vaccine mandates for health care workers (HCWs) in mid-2021. Prior research on the effect of these mandates was centered on the nursing home sector, and more evidence is needed for their effect on the entire HCW population.
To examine the association between state COVID-19 vaccine mandates for HCWs and vaccine uptake in this population.
DESIGN, SETTING, AND PARTICIPANTS: This repeated cross-sectional study included biweekly, individual-level data for adults aged 25 to 64 years who were working or volunteering in health care settings obtained from the Household Pulse Survey between May 26 and October 11, 2021. Analyses were conducted between November 2022 and October 2023.
Announcement of a state COVID-19 vaccine mandate for HCWs.
An indicator for whether a sampled HCW ever received a COVID-19 vaccine and an indicator for whether an HCW completed or intended to complete the primary COVID-19 vaccination series. Event study analyses using staggered difference-in-differences methods compared vaccine uptake among HCWs in mandate and nonmandate states before and after each mandate announcement. The sample was further stratified by the availability of regular COVID-19 testing in place of a vaccination (ie, a test-out option) and by the ages of HCWs (25-49 or 50-64 years) to examine heterogeneous associations.
The study sample included 31 142 HCWs (mean [SD] age, 45.5 [10.6] years; 72.1% female) from 45 states, 16 of which introduced COVID-19 vaccine mandates for HCWs. Results indicated a mandate-associated 3.46-percentage point (pp) (95% CI, 0.29-6.63 pp; P = .03) increase in the proportion of HCWs ever vaccinated against COVID-19 and a 3.64-pp (95% CI, 0.72-6.57 pp; P = .02) increase in the proportion that completed or intended to complete the primary vaccination series 2 weeks after mandate announcement from baseline proportions of 87.98% and 86.12%, respectively. In the stratified analyses, positive associations were only detected in mandate states with no test-out option and among HCWs aged 25 to 49 years, which suggested vaccination increases of 3.32% to 7.09% compared with baseline proportions.
This repeated cross-sectional study found that state COVID-19 vaccine mandates for HCWs were associated with increased vaccine uptake among HCWs, especially among younger HCWs and those in states with no test-out option. These findings suggest the potential for vaccine mandates to further promote vaccinations in an already highly vaccinated HCW population, especially when no test-out option is in place.
2021 年年中，17 个州对医护人员（HCW）推出了 COVID-19 疫苗强制接种令。先前关于这些命令对护理院部门影响的研究，需要更多证据来证明其对整个 HCW 人群的影响。
研究州 COVID-19 疫苗强制接种令对 HCW 疫苗接种率的影响。
设计、地点和参与者：本重复横断面研究包括 2021 年 5 月 26 日至 10 月 11 日期间从家庭脉搏调查中获得的 25 至 64 岁在医疗保健环境中工作或志愿工作的成年人的每两周一次的个体水平数据。分析于 2022 年 11 月至 2023 年 10 月进行。
州 COVID-19 疫苗强制接种令的宣布。
抽样 HCW 是否曾经接种过 COVID-19 疫苗的指标和 HCW是否完成或打算完成 COVID-19 初级疫苗接种系列的指标。使用交错差异差异法的事件研究分析比较了每个命令宣布前后在命令和非命令州的 HCW 中的疫苗接种率。根据是否提供常规 COVID-19 检测作为替代接种（即检测替代选项）以及 HCW 的年龄（25-49 岁或 50-64 岁）对样本进行进一步分层，以检查异质关联。
研究样本包括来自 45 个州的 31422 名 HCW（平均[标准差]年龄为 45.5[10.6]岁；72.1%为女性），其中 16 个州对 HCW 推出了 COVID-19 疫苗强制接种令。结果表明，与基线相比，命令相关的 COVID-19 疫苗接种率增加了 3.46 个百分点（95%CI，0.29-6.63 个百分点；P=.03），分别为 87.98%和 86.12%。完成或打算完成初级疫苗接种系列的 HCW 比例增加了 3.64 个百分点（95%CI，0.72-6.57 个百分点；P=.02）。在分层分析中，仅在没有检测替代选项的命令州和 25 至 49 岁的 HCW 中发现了阳性关联，这表明与基线比例相比，疫苗接种率增加了 3.32%至 7.09%。
本重复横断面研究发现，州 COVID-19 疫苗强制接种令与 HCW 疫苗接种率的增加有关，尤其是在年轻 HCW 和没有检测替代选项的州。这些发现表明，疫苗强制接种令有可能进一步促进已经高度接种疫苗的 HCW 人群的疫苗接种，尤其是在没有检测替代选项的情况下。
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