确定措施,以了解和解决在北卡罗来纳州青少年HPV疫苗接种范围的县级差异
Brigid K Grabert1,2, Mary Catharine McKeithen3, Justin G Trogdon4,5
1Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
在北卡罗来纳州,县级的农村化措施没有显示出人类乳头瘤病毒 (HPV) 疫苗接种覆盖率的差异. 社会脆弱性和儿科医生访问更好地解释了疫苗接种缺口,指导了质量改善工作.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在美国,人类乳头瘤病毒 (HPV) 疫苗接种范围存在地理差异,农村地区的疫苗接种率较低.
- 了解不同农村措施如何表征这些差异对于有针对性的质量改进工作至关重要.
研究的目的:
- 评估各种县级农村措施与北卡罗来纳州HPV疫苗接种范围之间的关联.
- 确定哪些因素最能解释州内HPV疫苗接种率的地理差异.
主要方法:
- 负二项回归模型分析了北卡罗来纳州青少年 (n=326,345) 五项农村措施和HPV疫苗接种覆盖率 (≥1剂量) 之间的关联.
- 农村度量包括OMB大都市统计区,农村-城市连续码,相对农村度指数,美国人口普查局和NC农村中心分类.
- 对社会脆弱性指数 (SVI) 和儿科医生密度进行控制的模型,使用NC免疫注册表的数据.
主要成果:
- 整个北卡罗来纳州的HPV疫苗接种率为29%.
- 在调整后,五个农村化措施中没有一个与HPV疫苗接种覆盖率有显著的相关性.
- 更高的社会脆弱性指数 (SVI) 和更高的儿科医生密度与更高的疫苗接种率 (P <0.01) 有积极的关联.
结论:
- 在本研究中定义的县级农村化措施没有有效地确定北卡罗来纳州HPV疫苗接种覆盖率的差异.
- 社会脆弱性和儿科医生接入似乎是理解和解决县级疫苗接种覆盖率差距的更相关因素.
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