Lyons Carrie, Nambiar Devaki, Johns Nicole E, Allorant Adrien, Bergen Nicole, Hosseinpoor Ahmad Reza
Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland.
Vaccines (Basel). 2024 Jul 29;12(8):850. doi: 10.3390/vaccines12080850.
Immunization through vaccines among children has contributed to improved childhood survival and health outcomes globally. However, vaccine coverage among children is unevenly distributed across settings and populations. The measurement of inequalities is essential for understanding gaps in vaccine coverage affecting certain sub-populations and monitoring progress towards achieving equity. Our study aimed to characterize the methods of reporting inequalities in childhood vaccine coverage, inclusive of the settings, data source types, analytical methods, and reporting modalities used to quantify and communicate inequality. We conducted a scoping review of publications in academic journals which included analyses of inequalities in vaccination among children. Literature searches were conducted in PubMed and Web of Science and included relevant articles published between 8 December 2013 and 7 December 2023. Overall, 242 publications were identified, including 204 assessing inequalities in a single country and 38 assessing inequalities across more than one country. We observed that analyses on inequalities in childhood vaccine coverage rely heavily on Demographic Health Survey (DHS) or Multiple Indicator Cluster Surveys (MICS) data (39.3%), and papers leveraging these data had increased in the last decade. Additionally, about half of the single-country studies were conducted in low- and middle-income countries. We found that few studies analyzed and reported inequalities using summary measures of health inequality and largely used the odds ratio resulting from logistic regression models for analyses. The most analyzed dimensions of inequality were economic status and maternal education, and the most common vaccine outcome indicator was full vaccination with the recommended vaccine schedule. However, the definition and construction of both dimensions of inequality and vaccine coverage measures varied across studies, and a variety of approaches were used to study inequalities in vaccine coverage across contexts. Overall, harmonizing methods for selecting and categorizing dimensions of inequalities as well as methods for analyzing and reporting inequalities can improve our ability to assess the magnitude and patterns of inequality in vaccine coverage and compare those inequalities across settings and time.
通过疫苗对儿童进行免疫接种有助于全球儿童生存率的提高和健康状况的改善。然而，儿童疫苗接种覆盖率在不同地区和人群中的分布并不均衡。对不平等现象的衡量对于理解影响某些亚人群的疫苗接种覆盖率差距以及监测实现公平方面的进展至关重要。我们的研究旨在描述报告儿童疫苗接种覆盖率不平等现象的方法，包括用于量化和传达不平等现象的背景、数据源类型、分析方法和报告方式。我们对学术期刊上的出版物进行了范围综述，这些出版物包括对儿童疫苗接种不平等现象的分析。在PubMed和科学网进行了文献检索，纳入了2013年12月8日至2023年12月7日期间发表的相关文章。总体而言，共识别出242篇出版物，其中204篇评估了单个国家内的不平等现象，38篇评估了多个国家之间的不平等现象。我们观察到，关于儿童疫苗接种覆盖率不平等现象的分析严重依赖人口与健康调查（DHS）或多指标类集调查（MICS）数据（39.3%），并且在过去十年中利用这些数据发表论文的数量有所增加。此外，约一半的单个国家研究是在低收入和中等收入国家进行的。我们发现，很少有研究使用健康不平等汇总指标来分析和报告不平等现象，并且在很大程度上使用逻辑回归模型得出的比值比进行分析。不平等现象分析最多的维度是经济状况和母亲教育程度，最常见的疫苗接种结果指标是按照推荐的疫苗接种程序完成全程接种。然而，不平等现象的两个维度以及疫苗接种覆盖率衡量指标的定义和构建在不同研究中各不相同，并且使用了多种方法来研究不同背景下疫苗接种覆盖率的不平等现象。总体而言，统一不平等现象维度的选择和分类方法以及不平等现象的分析和报告方法，可以提高我们评估疫苗接种覆盖率不平等现象的程度和模式以及跨背景和时间比较这些不平等现象的能力。
