Pearce A, Henery P, Dundas R, Katikireddi S V, Leyland A H, Cameron J C
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom.
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom.
Vaccine. 2025 May 31;57:127222. doi: 10.1016/j.vaccine.2025.127222. Epub 2025 May 14.
Childhood vaccination coverage in Scotland is relatively high, with relatively small inequalities by area deprivation prior to the COVID-19 pandemic. However, socio-economic inequalities using measures of individual socioeconomic circumstances can substantially differ. With inequalities in immunisation coverage widening, a fuller understanding of the social patterning across whole populations is required. We analysed a whole population, linked administrative cohort, born in Scotland 2009-2013 (n = 187,815), followed until 2018 (average age 6 years(y)). We examined three measures of socio-economic circumstances (SECs): area deprivation, mother's occupational class, and parents' relationship status at birth. We examined proportions unimmunised (and partially immunised, where relevant) for: primary vaccinations, first and second doses of MMR (MMR1/2), and preschool immunisations, at the WHO target ages. Inequalities were quantified using binary/multinomial logistic regression and the relative index of inequality (a regression-based measure comparing the hypothetically most vs least disadvantaged). We also estimated inequalities in average age when 95 % coverage was achieved. Ninety-eight percent were fully immunised with primary vaccines by 1y, and 96.4 % with MMR1 by 2y. Uptake of MMR2 and preschool immunisation was lower (94.2 % and 94.9 %, by 5y). Children living in more deprived areas and households were more likely to be unimmunised with MMR1-2 and preschool vaccines at target ages. Children from more deprived areas were more likely to be partially immunised but less likely to be unimmunised with the primary vaccines, whereas more consistent socio-economic gradients in both outcomes were seen by family-level SECs. Inequalities were especially large according to occupational class. Children from the most advantaged families reached 95 % primary vaccine coverage ∼4-months ahead of the least advantaged. Routine reports of immunisation uptake according to area deprivation are informative but can mislead if used to understand family-level socio-economic health inequalities. Data linkage provides opportunities to monitor family-level socio-economic inequality and inform immunisation programmes tailored to the needs of different groups.
在苏格兰，儿童疫苗接种覆盖率相对较高，在2019冠状病毒病大流行之前，按地区贫困程度划分的不平等程度相对较小。然而，使用个人社会经济状况衡量标准得出的社会经济不平等可能会有很大差异。随着免疫接种覆盖率不平等的加剧，需要更全面地了解整个人口中的社会模式。我们分析了2009年至2013年在苏格兰出生（n = 187,815）并随访至2018年（平均年龄6岁）的全人群关联行政队列。我们研究了三种社会经济状况（SEC）衡量标准：地区贫困程度、母亲的职业阶层以及出生时父母的关系状况。我们在世界卫生组织规定的目标年龄，检查了以下几种未接种疫苗（以及在相关情况下部分接种疫苗）的比例：基础疫苗接种、麻疹-腮腺炎-风疹疫苗（MMR）第一剂和第二剂（MMR1/2）以及学龄前免疫接种。使用二元/多项逻辑回归和不平等相对指数（一种基于回归的衡量标准，比较假设中最弱势与最不弱势的群体）对不平等进行量化。我们还估计了达到95%覆盖率时的平均年龄不平等情况。到1岁时，98%的儿童完成了基础疫苗的全程接种，到2岁时，96.4%的儿童接种了MMR1。MMR2和学龄前免疫接种的接种率较低（到5岁时分别为94.2%和94.9%）。生活在更贫困地区和家庭的儿童在目标年龄更有可能未接种MMR1-2和学龄前疫苗。来自更贫困地区的儿童更有可能部分接种疫苗，但未接种基础疫苗的可能性较小，而按家庭层面的社会经济状况衡量标准，在这两种结果中都观察到了更一致的社会经济梯度。根据职业阶层划分的不平等尤为明显。最具优势家庭的儿童比最不具优势家庭的儿童提前约4个月达到95%的基础疫苗接种覆盖率。根据地区贫困程度进行的免疫接种率常规报告提供了有用信息，但如果用于理解家庭层面的社会经济健康不平等情况，可能会产生误导。数据关联为监测家庭层面的社会经济不平等以及为满足不同群体需求而制定免疫接种计划提供了机会。
