定义和估计疫苗接种计划直接避免的结果,当疫苗接种随着时间的推移而发生时
Katherine M Jia1, Christopher B Boyer2,3, Alyssa Bilinski4,5
1Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Epidemiology (Cambridge, Mass.)
|January 22, 2026
概括
估计疫苗的影响需要仔细的定义. 本研究定义了"直接避免"的结果,为总避免的结果提供了下限,并确定了常见估计方法中的偏差.
科学领域:
- 流行病学 流行病学
- 生物统计学 生物统计学
- 公共卫生 公共卫生
背景情况:
- 在COVID-19等大流行期间,准确估计疫苗的有效性对于公共卫生至关重要.
- 之前的研究经常估计"直接避免"的死亡,可能低估了总影响,没有充分考虑间接影响.
研究的目的:
- 定义因果估计,以及通过疫苗接种"直接避免"的结果,表示对接种疫苗的个体的影响,同时保持覆盖率恒定.
- 在随机对照试验 (RCT) 中为这种因果估计开发一个不偏见的估计器.
- 分析常用的"危险差异"估计器的偏差.
主要方法:
- 因果推理框架来定义"直接避免"的结果.
- 为一阶段RCT开发一个不偏见的估计器.
- 模拟研究将拟议的估计器与"危险差异"估计器进行比较.
主要成果:
- 如果接种疫苗具有非零效应,则在RCT中"危险差异"估计器是有偏见的,原因是未能考虑未接种疫苗的人群中"易受体耗尽".
- "危险差异"估计器的高估值对于感染致死率低的死亡是最小的,但对于具有高疫苗疗效和高传染性的感染可能是相当大的.
- 定义并比较"可避免"的结果 (结果可以避免,但不是由于缺乏疫苗接种).
结论:
- 拟议的因果估计为总的疫苗预防结果提供了下限.
- "危险差异"估计器可能会导致严重的高估,特别是在避免感染的情况下.
- 需要进一步的研究来确定观察性研究中的因果估计值.
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