Akmatov Manas K, Kohring Claudia, Holstiege Jakob, Müller Doreen
Fachbereich Epidemiologie und Versorgungsatlas, Zentralinstitut für die kassenärztliche Versorgung, Salzufer 8, 10587, Berlin, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2025 Aug 18. doi: 10.1007/s00103-025-04103-8.
The aims of the study were to determine the influenza vaccination coverage among individuals aged 60 and older, examine spatial variations, and identify spatial clusters as well as regional risk factors for low vaccination coverage.
The study was based on nationwide outpatient claims data from 2022 and 2023. The study population consisted of 22,303,411 individuals with statutory health insurance aged 60 and older. The influenza vaccination coverage was calculated as the proportion of vaccinated individuals during the 2022/23 season among all persons with Statutory Health Insurance (SHI) who had contact with SHI-authorized physicians in 2022. Global spatial autocorrelation, local spatial clusters, and regional risk factors for low vaccination coverage were examined using global and local Moran's I as well as geographically weighted regression.
The nationwide influenza vaccination coverage was 37%, with district-level variations ranging from 10% to 61%. The global autocorrelation was 0.87 (global Moran's I, p < 0.0001). Two strongly pronounced local clusters were identified. A large spatial cluster with relatively high vaccination coverage spanned across all eastern federal states as well as districts in southeastern Lower Saxony, Schleswig-Holstein, and Hamburg. Another cluster with relatively low vaccination coverage encompassed almost all districts in southern Germany. The risk factors for low vaccination coverage included residence in western Germany and in sparsely populated rural districts. The density of general practitioners showed a positive correlation with vaccination coverage. The relationships between vaccination coverage and explanatory variables varied regionally.
The identification of spatial clusters and regional risk factors for low vaccination coverage can serve as a basis for regionally tailored intervention measures to improve vaccine uptake.
本研究的目的是确定60岁及以上人群的流感疫苗接种覆盖率，研究空间差异，识别空间聚集以及低接种覆盖率的区域风险因素。
本研究基于2022年和2023年全国门诊报销数据。研究人群包括22303411名60岁及以上参加法定医疗保险的个人。流感疫苗接种覆盖率的计算方法是2022/23季节接种疫苗的人数占2022年与法定医疗保险（SHI）授权医生有接触的所有法定医疗保险参保人员的比例。使用全局和局部莫兰指数以及地理加权回归分析低接种覆盖率的全局空间自相关、局部空间聚集和区域风险因素。
全国流感疫苗接种覆盖率为37%，地区层面的差异范围为10%至61%。全局自相关系数为0.87（全局莫兰指数，p<0.0001）。识别出两个明显的局部聚集区。一个接种覆盖率相对较高的大空间聚集区横跨所有东部联邦州以及下萨克森州东南部、石勒苏益格-荷尔斯泰因州和汉堡的一些地区。另一个接种覆盖率相对较低的聚集区几乎涵盖了德国南部的所有地区。低接种覆盖率的风险因素包括居住在德国西部和人口稀少的农村地区。全科医生的密度与接种覆盖率呈正相关。接种覆盖率与解释变量之间的关系存在区域差异。
识别低接种覆盖率的空间聚集和区域风险因素可为制定区域针对性干预措施以提高疫苗接种率提供依据。
