López-Sánchez Irene, Perramon-Malavez Aida, Soriano-Arandes Antoni, Prats Clara, Duarte-Salles Talita, Raventós Berta, Roel Elena
Real World Epidemiology Research Group, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain.
Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
Front Pediatr. 2024 Nov 19;12:1466884. doi: 10.3389/fped.2024.1466884. eCollection 2024.
This study aims to investigate the relationship between deprivation, as measured by a socioeconomic deprivation index (SDI) score for census tract urban areas, and COVID-19 infections and vaccine uptake among children and adolescents before and after the vaccination rollout in Catalonia, Spain.
We conducted a population-based cohort study using primary care records. Individuals were followed 3 months before the start of the vaccination campaign in Spain and 3 months after. Children (5-11 years) and adolescents (12-15 years) with at least 1 year of prior history observation available and without missing deprivation data. For each outcome, we estimated cumulative incidence and crude Cox proportional-hazard models by SDI quintiles, and hazard ratios (HRs) of COVID-19 infection and vaccine uptake relative to the least deprived quintile, Q1.
Before COVID-19 vaccination rollout, 290,625 children and 179,685 adolescents were analyzed. Increased HR of deprivation was associated with a higher risk of COVID-19 infection in both children [Q5: 1.55 (95% CI, 1.47-1.63)] and adolescents [Q5: 1.36 (95% CI, 1.29-1.43)]. After the rollout, this pattern changed among children, with lower risk of infection in more deprived areas [Q5: 0.62 (95% CI, 0.61-0.64)]. Vaccine uptake was higher among adolescents than children, but in both age groups, non-vaccination was more common among those living in more deprived areas (39.3% and 74.6% in Q1 vs. 26.5% and 66.9% in Q5 among children and adolescents, respectively).
Children and adolescents living in deprived areas were at higher risk of COVID-19 non-vaccination. Socioeconomic disparities in COVID-19 infection were also evident before vaccine rollout, with a higher infection risk in deprived areas across age groups. Our findings suggest that changes in the association between deprivation and infections among children after the vaccine rollout were likely due to testing disparities.
本研究旨在调查以人口普查区城市地区的社会经济剥夺指数（SDI）得分衡量的剥夺与西班牙加泰罗尼亚疫苗接种推出前后儿童和青少年中新冠病毒感染及疫苗接种率之间的关系。
我们使用初级保健记录进行了一项基于人群的队列研究。在西班牙疫苗接种活动开始前3个月和开始后3个月对个体进行随访。纳入有至少1年既往观察史且无缺失剥夺数据的儿童（5 - 11岁）和青少年（12 - 15岁）。对于每个结局，我们按SDI五分位数估计累积发病率和粗Cox比例风险模型，以及相对于最不贫困五分位数Q1的新冠病毒感染和疫苗接种率的风险比（HRs）。
在新冠病毒疫苗接种推出前，分析了290,625名儿童和179,685名青少年。剥夺程度增加与儿童[Q5：1.55（95%CI，1.47 - 1.63）]和青少年[Q5：1.36（95%CI，1.29 - 1.43）]中新冠病毒感染风险较高相关。疫苗接种推出后，儿童中的这种模式发生了变化，在更贫困地区感染风险较低[Q5：0.62（95%CI，0.61 - 0.64）]。青少年的疫苗接种率高于儿童，但在两个年龄组中，居住在更贫困地区的人群中未接种疫苗更为常见（儿童中Q1为39.3%，Q5为26.5%；青少年中Q1为74.6%，Q5为66.9%）。
生活在贫困地区的儿童和青少年未接种新冠病毒疫苗的风险更高。在疫苗推出前，新冠病毒感染方面的社会经济差异也很明显，各年龄组中贫困地区的感染风险更高。我们的研究结果表明，疫苗接种推出后儿童中剥夺与感染之间关联的变化可能是由于检测差异所致。
