Sheehan Jessica L, Jordan Ariel A, Newman Kira L, Johnson Laura A, Eloubeidi Dala, Cohen-Mekelburg Shirley, Berinstein Jeffrey A, Tipirneni Renuka, Higgins Peter D R
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Dig Dis Sci. 2025 Jan;70(1):136-145. doi: 10.1007/s10620-024-08733-x. Epub 2024 Nov 15.
Social determinants of health (SDOH) have a known impact on disparities in vaccination. Despite an increased risk for infection in patients with inflammatory bowel disease (IBD), SDOH and vaccination in this population have not been studied. Using census tract-level data from the Centers for Disease Control's social vulnerability index (SVI), we aimed to understand the relationship between SDOH and adherence to guideline-recommended vaccinations in patients with IBD.
A single-center retrospective cohort of patients with IBD was used to geocode patient addresses to their individual census tract and corresponding SVI and subthemes (Socioeconomic Status, Household Composition, Minority Status, and Housing/Transportation). We used separate multivariable logistic regressions to examine the relationship between SVI and vaccination against influenza, COVID-19, pneumococcal pneumonia, and herpes zoster.
A total of 7,036 patients were included. Rates of vaccination varied across vaccine-types: influenza (57%), COVID-19 (65%), pneumococcal pneumonia (58%), and herpes zoster (11%). High social vulnerability was associated with lower odds of vaccination against influenza (OR 0.47, p < 0.001), COVID-19 (OR 0.54, p < 0.001), pneumonia (OR 0.73, p = 0.012), and herpes zoster (OR 0.39, p < 0.001). Within the SVI subthemes, Socioeconomic Status, Household Composition, and Minority Status were important factors associated with differences in vaccine uptake.
Higher social vulnerability was associated with lower rates of vaccination across all vaccine types. Identifying these disparities in vaccination for socially vulnerable patients with IBD is the first step to reducing preventable infections and ensuring all patients receive high quality, equitable care.
健康的社会决定因素（SDOH）对疫苗接种差异有已知影响。尽管炎症性肠病（IBD）患者感染风险增加，但该人群中的SDOH和疫苗接种情况尚未得到研究。我们利用美国疾病控制中心社会脆弱性指数（SVI）的普查区层面数据，旨在了解SDOH与IBD患者遵循指南推荐疫苗接种之间的关系。
采用IBD患者的单中心回顾性队列，将患者地址地理编码到其各自的普查区以及相应的SVI和子主题（社会经济地位、家庭构成、少数族裔地位以及住房/交通）。我们使用单独的多变量逻辑回归来研究SVI与流感、新冠病毒、肺炎球菌肺炎和带状疱疹疫苗接种之间的关系。
共纳入7036例患者。不同疫苗类型的接种率各不相同：流感疫苗（57%）、新冠疫苗（65%）、肺炎球菌肺炎疫苗（58%）和带状疱疹疫苗（11%）。高社会脆弱性与流感疫苗接种几率较低（比值比[OR]0.47，p<0.001）、新冠疫苗接种几率较低（OR 0.54，p<0.001）、肺炎疫苗接种几率较低（OR 0.73，p=0.012）以及带状疱疹疫苗接种几率较低（OR 0.39，p<0.001）相关。在SVI子主题中，社会经济地位、家庭构成和少数族裔地位是与疫苗接种差异相关的重要因素。
较高的社会脆弱性与所有疫苗类型的较低接种率相关。识别IBD社会脆弱患者在疫苗接种方面的这些差异是减少可预防感染并确保所有患者获得高质量、公平护理的第一步。
