Population-level assessment of early childhood vaccination timeliness, parental vaccine hesitancy, and immunization schedule adherence in the United States, including rural-urban disparities

对美国幼儿疫苗接种及时性、父母疫苗犹豫和免疫计划遵守情况的人群评估，包括城乡差异

• 批准号: 10491800
• 负责人: Sophia Raff Newcomer
• 金额: $ 42.18万
• 依托单位: UNIVERSITY OF MONTANA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-21 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10491800
• 关键词: Achievement; Address; Adherence; Advisory Committees; Affect; Age; Algorithms; Area; Binomial Model; Birth; COVID-19 pandemic effects; Cessation of life; Child; Childhood; Communicable Diseases; Complex; Data; Data Sources; Disease; Disease Outbreaks; Dose; Goals; Immunization; Immunization Schedule; Intervention; Link; Measles; Measures; Methods; Modeling; Modification; Parents; Pattern; Pertussis; Population; Prevalence; Public Health; Records; Risk Factors; Rural; Schedule; Series; Services; Surveillance Methods; Surveys; Testing; Time; United States; Vaccinated; Vaccination; Vaccines; Vulnerable Populations; Work; contextual factors; disorder control; disorder risk; early childhood; experience; health care availability; health equity; health goals; improved; novel; population based; prevent; public health intervention; rural area; rurality; socioeconomics; standard measure; suburb; trend; urban disparity; vaccination schedule; vaccine acceptance; vaccine hesitancy

Project Summary/Abstract Delivery of early childhood vaccines using an established schedule is a key strategy for infectious disease control in the United States. However, between 50% and 75% of U.S. children experience undervaccination, defined as either getting some or all recommended vaccines late or not getting them at all, before their 2nd birthday. Outbreaks of measles, pertussis, and other vaccine-preventable diseases have been linked to children who were behind on or missing vaccines, either due to parental vaccine hesitancy or other barriers to accessing immunization services. There are currently no systematic, population-based approaches for tracking adherence to the U.S. recommended immunization schedule, or the prevalence of parents who choose to deviate from the recommended schedule. Furthermore, standard measures are inadequate for identifying the reasons why we fail to achieve vaccine coverage goals, which is a particular problem in populations that experience immunization disparities, including children living in the rural U.S. For this project, we will analyze 11 years of public use data collected in the National Immunization Survey-Child (NIS-Child) to quantify four novel measures of early childhood immunization services quality: (1) vaccine timeliness, (2) immunization schedule adherence, (3) undervaccination due to parental vaccine hesitancy, and (4) undervaccination due to other access barriers. In our analyses of this nationally representative data source, we will identify trends in and factors associated with these measures in the U.S. overall in 2011-2019 (Specific Aim 1a), for each U.S. state in 2011-2019 (Specific Aim 1b), and assess how the COVID-19 pandemic affected these trends in 2020-2021 (Specific Aim 1c). We will use mixed effects log-binomial models and zero-inflated Poisson models, as well as piecewise regression methods, to determine how time, socioeconomic, demographic, and other factors have affected these immunization quality measures in and across the U.S. Then, we will access restricted use NIS-Child data to determine how trends in and factors associated with immunization schedule adherence and specific undervaccination patterns are modified by rurality (Specific Aim 2). Our proposed analyses, along with our dissemination efforts, will contribute to the long-term goal of establishing methods for routine surveillance of these early childhood immunization services quality measures at national, state, and some local levels. Furthermore, this study will establish new data-driven methods for distinguishing between undervaccination due to parental vaccine hesitancy versus other healthcare access barriers; an important distinction, since interventions to address these two types of barriers fundamentally differ. The results from this project, and particularly the examinations of effect modification by rurality, will inform targeted interventions for increasing on-time vaccination and immunization schedule adherence, decreasing vaccine-preventable disease risk, and achieving immunization coverage equity in early childhood.

项目摘要/摘要 使用既定时间表交付幼儿疫苗是传染病的关键策略 在美国的控制。但是，美国儿童中有50％至75％的人遭受疫苗不足， 定义为迟到或全部推荐的疫苗，或者根本不接种疫苗 生日。麻疹，百日咳和其他可预防疾病的爆发已与 因父母疫苗犹豫或其他障碍而落后或缺少疫苗的孩子 访问免疫服务。目前没有系统的，基于人群的方法 跟踪遵守美国建议的免疫时间表或父母的患病率 选择偏离建议的时间表。此外，标准措施不足 确定我们无法实现疫苗覆盖目标的原因，这是一个特定的问题 经历免疫差异的人群，包括居住在美国农村的儿童， 我们将分析国家免疫调查子（NIS-Child）中收集的11年公共使用数据 量化幼儿免疫服务质量的四个新颖的​​衡量标准：（1）疫苗及时性，（2） 免疫计划依从性，（3）由于父母疫苗的犹豫而引起的疫苗不足，（4） 由于其他访问障碍而导致的疫苗不足。在我们对这个国家代表性数据源的分析中 我们将确定2011 - 2019年美国总体上与美国这些措施相关的趋势和因素（具体 AIM 1A），2011 - 2019年美国每个州（特定目标1B），并评估COVID-19的大流行如何影响 这些趋势在2020 - 2021年（特定AIM 1C）。我们将使用混合效果对数二项式模型和零充气 泊松模型以及分段回归方法，以确定时间，社会经济， 人口统计以及其他因素影响了美国和整个美国的这些免疫质量措施 然后，我们将访问限制使用NIS-Child数据，以确定与之相关的趋势和因素 免疫计划依从性和特定缺乏疫苗的模式是通过农村修改的（特定的目的 2）。我们提出的分析以及我们的传播努力将有助于长期目标 建立对这些幼儿免疫服务服务质量指标的常规监视方法 在国家，州和一些地方层面。此外，这项研究将建立新的数据驱动方法 区分由于父母疫苗犹豫不决而导致的不足与其他医疗保健访问 障碍；一个重要的区别，因为从根本上解决这两种障碍的干预措施 不同。该项目的结果，尤其是对农村的效应修改检查的结果，将 告知有针对性的干预措施以增加准时疫苗接种和免疫计划遵守， 降低可预防疫苗的疾病风险，并在幼儿期达到免疫覆盖范围。