Ohta Ryuichi, Yakabe Toshihiro, Adachi Hiroshi, Sano Chiaki
Community Care, Unnan City Hospital, Unnan, JPN.
Family Medicine, Unnan City Hospital, Unnan, JPN.
Cureus. 2024 Jul 24;16(7):e65293. doi: 10.7759/cureus.65293. eCollection 2024 Jul.
Introduction Vaccination is essential for preventing infectious diseases such as pneumonia and seasonal viral infections. The COVID-19 pandemic has underscored the critical role of vaccination in public health. However, vaccination uptake can be influenced by biopsychosocial conditions. Immunocompromised individuals, for instance, face restrictions with live vaccines, and psychosocial factors like loneliness can negatively impact attitudes towards vaccination. This study aims to clarify the association between loneliness and pneumococcal vaccination rate among regular patients in a rural Japanese community. Method A cross-sectional study was conducted at Unnan City Hospital in Unnan City, a rural area in southeastern Shimane Prefecture, Japan. Participants included patients over 40 who regularly visited the general medicine department between September 1, 2023, and November 31, 2023. Data on vaccination rates for pneumococcal pneumonia and loneliness levels assessed using the Japanese version of the three-item University of California, Los Angeles (UCLA) Loneliness Scale were collected. Additional data on demographics, BMI, renal function, and comorbidities were extracted from electronic medical records. Statistical analyses were performed to identify factors associated with vaccination rates, including univariate and multivariate logistic regression. Results Out of 1,024 eligible patients, 647 participated in the study. Participants with higher loneliness had significantly lower vaccination rates for pneumococcal pneumonia (22.3% vs. 34.2%, p = 0.001). The multivariate logistic regression model showed that higher loneliness was significantly associated with lower vaccination likelihood (odds ratio (OR) = 0.54, 95% CI = 0.37-0.78, p = 0.0011). Age was positively associated with vaccination (OR = 1.08, 95% CI = 1.06-1.11, p < 0.001), whereas higher comorbidity scores (Charlson Comorbidity Index (CCI) ≥ 5) and frequent healthy eating practices were associated with lower vaccination rates. Conclusion This study demonstrates a significant association between higher loneliness levels and lower pneumococcal vaccination rates among patients in a rural Japanese community. Addressing psychosocial barriers such as loneliness could enhance vaccination uptake. Public health interventions focused on reducing loneliness and enhancing social support are essential to improving vaccination rates and preventing infectious diseases. Further research should explore the causal mechanisms and develop targeted strategies to mitigate the impact of loneliness on health behaviors.
引言
疫苗接种对于预防肺炎和季节性病毒感染等传染病至关重要。新冠疫情凸显了疫苗接种在公共卫生中的关键作用。然而，疫苗接种率可能会受到生物心理社会因素的影响。例如，免疫功能低下的个体在接种活疫苗时会受到限制，而孤独等社会心理因素会对疫苗接种态度产生负面影响。本研究旨在阐明日本农村社区普通患者中孤独感与肺炎球菌疫苗接种率之间的关联。
方法
在日本岛根县东南部农村地区的云南市立医院进行了一项横断面研究。参与者包括2023年9月1日至2023年11月31日期间定期到普通内科就诊的40岁以上患者。收集了使用日本版三项加州大学洛杉矶分校（UCLA）孤独感量表评估的肺炎球菌肺炎疫苗接种率和孤独感水平数据。从电子病历中提取了有关人口统计学、体重指数、肾功能和合并症的其他数据。进行了统计分析以确定与疫苗接种率相关的因素,包括单因素和多因素逻辑回归分析。
结果
在1024名符合条件的患者中，有647名参与了研究。孤独感较高的参与者肺炎球菌肺炎疫苗接种率显著较低（22.3%对34.2%，p=0.001）。多因素逻辑回归模型显示，孤独感较高与较低的疫苗接种可能性显著相关（优势比（OR）=0.54，95%置信区间=0.37-0.78，p=0.0011）。年龄与疫苗接种呈正相关（OR=1.08，95%置信区间=1.06-1.11，p<0.001），而较高的合并症评分（查尔森合并症指数（CCI）≥5）和频繁的健康饮食行为与较低的疫苗接种率相关。
结论
本研究表明，日本农村社区患者中较高的孤独感水平与较低的肺炎球菌疫苗接种率之间存在显著关联。解决孤独等社会心理障碍可以提高疫苗接种率。专注于减少孤独感和增强社会支持的公共卫生干预措施对于提高疫苗接种率和预防传染病至关重要。进一步的研究应探索因果机制，并制定有针对性的策略以减轻孤独感对健康行为的影响。
