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: 10689307
• 负责人: Sophia Raff Newcomer
• 金额: $ 41.79万
• 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/10689307
• 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; Disparity; Dose; Equity; Goals; Immunization; Immunization Schedule; Intervention; Link; Measles; Measures; Methods; Modeling; Modification; Parents; Pattern; Pertussis; Population; Prevalence; Public Health; Recommendation; Records; Risk Factors; Rural; Schedule; Series; Services; Surveillance Methods; Surveys; Testing; Time; United States; Vaccinated; Vaccination; Vaccines; Vulnerable Populations; Work; access restrictions; 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.

项目概要/摘要 按照既定时间表提供幼儿疫苗是应对传染病的关键策略 控制在美国。然而，50% 至 75% 的美国儿童疫苗接种不足， 定义为在第二次接种之前延迟接种部分或全部推荐疫苗或根本不接种 生日。麻疹、百日咳和其他疫苗可预防疾病的爆发与 由于父母对疫苗接种犹豫不决或其他障碍而未能接种或错过疫苗接种的儿童 获得免疫服务。目前尚无系统的、基于人群的方法 跟踪美国推荐的免疫接种计划的遵守情况，或父母有以下情况的患病率 选择偏离建议的时间表。此外，标准措施不足以 找出我们未能实现疫苗覆盖目标的原因，这是一个特殊问题 经历免疫差异的人群，包括生活在美国农村的儿童 对于这个项目， 我们将分析国家免疫调查儿童 (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项新指标：(1) 疫苗及时性，(2) 遵守免疫计划，(3) 由于父母对疫苗犹豫不决而导致疫苗接种不足，以及 (4) 由于其他准入障碍而导致疫苗接种不足。在我们对这个具有全国代表性的数据源的分析中， 我们将确定 2011-2019 年美国总体这些措施的趋势和相关因素（具体 目标 1a)，针对 2011-2019 年美国每个州（具体目标 1b），并评估 COVID-19 大流行的影响 2020-2021 年的这些趋势（具体目标 1c）。我们将使用混合效应对数二项式模型和零膨胀 泊松模型以及分段回归方法，以确定时间、社会经济、 人口统计和其他因素影响了美国境内和全国范围内的这些免疫质量措施。 然后，我们将访问限制使用 NIS-Child 数据，以确定与此相关的趋势和因素 农村地区改变了免疫计划的遵守情况和具体的疫苗接种不足模式（具体目标 2）。我们提出的分析以及我们的传播努力将有助于实现 建立对这些幼儿免疫服务质量措施进行常规监测的方法 在国家、州和一些地方层面。此外，本研究将建立新的数据驱动方法 区分由于父母对疫苗犹豫不决而导致的疫苗接种不足与其他医疗保健获取情况 障碍；这是一个重要的区别，因为从根本上解决这两类障碍的干预措施 不同。该项目的结果，特别是对农村地区影响修正的检验，将 告知有针对性的干预措施，以提高按时接种疫苗和免疫计划的遵守率， 降低疫苗可预防疾病的风险，并实现幼儿期免疫覆盖公平。