运用聚类分析探究美国完全接种疫苗的成年人中对医疗不信任程度不同的新冠疫苗加强针犹豫情况。
Using cluster analysis to explore COVID-19 vaccine booster hesitancy by levels of medical mistrust in fully vaccinated US adults.
机构信息
Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA.
Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, Pennsylvania, USA.
出版信息
Ann Med. 2024 Dec;56(1):2401122. doi: 10.1080/07853890.2024.2401122. Epub 2024 Sep 11.
BACKGROUND
Underlying causes of vaccine hesitancy could significantly affect successful uptake of the SARS-CoV2 vaccine booster doses during new waves of COVID-19. Booster rates among US adults are far below what is needed for immunity, but little is known about booster hesitancy among fully vaccinated adults and whether medical mistrust exacerbates barriers to uptake.
METHODS
A cross-sectional survey was completed among 119 adults in Philadelphia, PA who reported having received the primary SARS-CoV2 vaccine series but not a booster dose. Using the LaVeist Medical Mistrust (MM) Index, a k-means cluster analysis showed two clusters (Low MM, High MM) and differences in attitudes and perceptions about COVID-19 booster vaccines were assessed using F-tests.
RESULTS
Respondents were 62% Black and female; mean age was 41; 46% reported earning less than $25,000 and 53% had a high school education or less. Overall intention to get boosted was low (mean 3.3 on 0-10 scale). Differences in COVID-19 booster perceptions between those with High ( = 56) vs. Low ( = 59) MM were found, independent of any demographic differences. Most statements (7/10) related to reasons to not be boosted were significant, with those with High MM indicating more concern about feeling sick from the vaccine (F=-3.91, ≤ .001), beliefs that boosters are ineffective for vaccinated people (F= -3.46, ≤ .001), and long-term side effect worries (F=-4.34, ≤ .001). Those with High MM were also more concerned about the adverse effects of the vaccine (F=-2.48, =.02), but were more likely to trust getting information from doctors or healthcare providers (F= -2.25, =.03).
CONCLUSIONS
Results indicate that medical mistrust is an important independent construct when understanding current COVID-19 booster hesitancy. While much work has looked at demographic differences to explain vaccine hesitancy, these results suggest that further research into understanding and addressing medical mistrust could be important for implementing interventions to increase booster rates.
背景
疫苗犹豫的潜在原因可能会极大地影响 COVID-19 新一轮疫情期间 SARS-CoV2 疫苗加强针的接种率。美国成年人的加强针接种率远低于免疫所需水平，但对于完全接种疫苗的成年人对加强针的犹豫程度以及医疗不信任是否加剧了接种障碍知之甚少。
方法
在宾夕法尼亚州费城完成了一项横断面调查，调查对象是 119 名报告已完成 SARS-CoV2 初级疫苗系列接种但未接种加强针的成年人。使用 LaVeist 医疗不信任（MM）指数，采用 k-均值聚类分析显示了两个聚类（低 MM、高 MM），并使用 F 检验评估了对 COVID-19 加强疫苗的态度和看法的差异。
结果
受访者中 62%为黑人，女性占 41%；46%报告收入低于 25,000 美元，53%接受过高中或以下教育。总体而言，接种加强针的意愿较低（0-10 分制平均 3.3 分）。在 MM 较高（ = 56）与 MM 较低（ = 59）的个体之间，对 COVID-19 加强针的看法存在差异，这些差异独立于任何人口统计学差异。大多数（7/10）与不接种加强针的原因相关的陈述具有统计学意义，MM 较高的个体表示更担心接种疫苗后会生病（F=-3.91，≤.001），认为加强针对已接种疫苗的人无效（F=-3.46，≤.001），以及长期副作用的担忧（F=-4.34，≤.001）。MM 较高的个体也更担心疫苗的不良反应（F=-2.48，=.02），但更信任从医生或医疗保健提供者那里获取信息（F= -2.25，=.03）。
结论
结果表明，在理解当前 COVID-19 加强针犹豫时，医疗不信任是一个重要的独立因素。虽然许多研究都着眼于人口统计学差异来解释疫苗犹豫，但这些结果表明，进一步研究理解和解决医疗不信任问题可能对于实施提高加强针接种率的干预措施很重要。
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