医疗补助扩张是否改善了美国孕妇的免疫接种?
Junying Zhao1, Rashmi Jaggad2, Ahmed El Fatmaoui3
1Department of Health Administration and Policy, University of Oklahoma Health Sciences, 801 NE 13 Street CHB 359, Oklahoma City, OK 73104, United States.
Preventive medicine reports
|October 6, 2025
概括
负担得起的医疗保健法案 (ACA) 医疗补助扩张没有增加孕妇的疫苗接种率. 有针对性的非基于收入的政策可以改善这一群体的流感疫苗接种覆盖率.
科学领域:
- 公共卫生 公共卫生
- 卫生政策 卫生政策
- 孕产妇健康 孕产妇健康
背景情况:
- 可负担医疗法案 (ACA) 扩大了医疗补助资格,旨在改善低收入人群获得医疗保健的机会.
- 之前的研究表明,ACA医疗补助扩张对孕妇流感疫苗接种的影响是不同的,并且缺乏关于结核病,白血病和细胞性百日咳 (Tdap) 疫苗接种的数据.
研究的目的:
- 评估ACA医疗补助扩张对美国孕妇流感和Tdap疫苗接种概率的影响.
- 确定与这一群体接种疫苗相关的社会经济和人口因素.
主要方法:
- 利用三重差异方法分析来自怀孕风险评估监测系统 (2011-2015年) 和44320名孕妇的国家福利数据的合并数据.
- 在ACA后扩张状态 (治疗组) 的医疗补助计划注册人与扩张状态的非医疗补助计划注册人以及非扩张状态 (控制组) 的所有个人之间比较疫苗接种率.
主要成果:
- ACA医疗补助扩张并没有显著增加孕妇接种疫苗的概率.
- 与ACA前非医疗补助计划注册者相比,ACA后的医疗补助计划注册者显示,接种疫苗的可能性下降了4.5-9%.
- 特定的人口群体的疫苗接种概率有所不同:非洲裔美国人 (4-5%不太可能),美洲原住民 (3-7%更有可能),低平价人口 (3.2-5.4%更有可能),大学受过教育的人 (4.8-10.6%更有可能).
- 高贫困州的孕妇接种流感疫苗的可能性降低了0.6%.
结论:
- 在ACA下以收入为基础的医疗补助扩张并没有提高孕妇的疫苗接种率.
- 不基于收入的政策可能有利于在扩张州接种Medicaid注册孕妇的疫苗.
- 未来的干预措施应该考虑针对高平价,低教育和居住在高贫困,非扩张国家的非洲裔美国孕妇.
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