Rodewald L E, Szilagyi P G, Shiuh T, Humiston S G, LeBaron C, Hall C B
Department of Pediatrics, University of Rochester, NY, USA.
Arch Pediatr Adolesc Med. 1995 Apr;149(4):393-7. doi: 10.1001/archpedi.1995.02170160047007.
To test the hypothesis that the underimmunization of young children is a marker for the lack of preventive and acute primary care.
Primary care center serving an impoverished population (90% Medicaid).
Historical cohort study (N = 1178) of children aged 12 to 30 months that determined each child's immunization status, anemia, tuberculosis, and lead screening status; and office utilization history. Screening delay was defined as missing a recommended screening by more than 3 months past the standard screening age.
Thirty-four percent of the population were underimmunized at 12 months of age. Compared with fully immunized children, these children were at greater risk for screening delay: anemia, 38% vs 5% (risk ratio [RR], 7.5; 95% confidence interval [CI], 5.4 to 10.4); tuberculosis, 76% vs 44% (RR, 1.7; CI, 1.6 to 1.9); and lead, 69% vs 33% (RR, 2.1; CI, 1.9 to 2.4). These RRs increased with greater immunization delay. Compared with fully immunized children, the underimmunized group made 47% fewer preventive health visits (2.5 vs 4.7 visits per infant per year, P < .001) and 43% fewer illness visits (2.5 vs 4.4, P < .001) and had 50% more missed appointments (2.1 vs 1.4, P < .001). Logistic regression, predicting anemia screening delay at 12 months of age, showed that underimmunization had an effect independent of utilization, with an odds ratio of 7.7 (CI, 5.2 to 12.0).
Underimmunization was a powerful, independent marker for inadequate health supervision in this population.
The current emphasis on immunizations has the benefit of targeting children at risk of lack of preventive and acute care. Improving immunization rates may have the potential to improve other aspects of primary care if immunization provision is not uncoupled from primary care.
检验幼儿免疫接种不足是缺乏预防和急性初级保健标志这一假设。
为贫困人群（90%为医疗补助对象）服务的初级保健中心。
对12至30个月大儿童进行的历史性队列研究（N = 1178），确定每个儿童的免疫接种状况、贫血、结核病和铅筛查状况以及就诊利用史。筛查延迟定义为超过标准筛查年龄3个月以上未进行推荐的筛查。
34%的人群在12个月大时免疫接种不足。与完全免疫接种的儿童相比，这些儿童筛查延迟的风险更高：贫血，38%对5%（风险比[RR]，7.5；95%置信区间[CI]，5.4至10.4）；结核病，76%对44%（RR，1.7；CI，1.6至1.9）；铅，69%对33%（RR，2.1；CI，1.9至2.4）。这些RR随着免疫接种延迟增加而升高。与完全免疫接种的儿童相比，免疫接种不足组的预防性健康就诊少47%（每名婴儿每年2.5次对4.7次，P <.001），疾病就诊少43%（2.5次对4.4次，P <.001），错过预约多50%（2.1次对1.4次，P <.001）。预测12个月大时贫血筛查延迟的逻辑回归显示，免疫接种不足有独立于就诊利用的影响，比值比为7.7（CI，5.2至12.0）。
免疫接种不足是该人群健康监督不足的一个有力独立标志。
当前对免疫接种的重视有利于针对有缺乏预防和急性护理风险的儿童。如果免疫接种服务与初级保健不脱节，提高免疫接种率可能有改善初级保健其他方面的潜力。
