PO.PR01.01 · 预防研究
考察不同临床环境下乙型肝炎疫苗接种的结构性与社会性驱动因素
Examining structural and social drivers of hepatitis B vaccination across diverse clinical settings
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
乙型肝炎是美国肝癌的主要病因，同时也与非霍奇金淋巴瘤、胰腺癌以及头颈部癌症风险升高相关。尽管乙型肝炎疫苗在预防慢性感染及随后癌症发生方面高度有效，但接种率仍然偏低：2021年，19岁及以上成人的乙型肝炎疫苗接种覆盖率为34.2%。本研究评估青少年和青年人群在不同诊所环境、人口统计学特征及健康社会决定因素（SDOH）方面的乙型肝炎全程疫苗接种完成情况，以识别疫苗覆盖方面的差距并降低乙型肝炎感染的发生率。我们采用回顾性横断面分析，利用来自南佛罗里达大学（University of South Florida）卫生系统内青少年医学科、儿科感染病科、内科-儿科联合科及家庭医学科诊所以及Ybor青年诊所（USF儿科系下属的一家社区性健康诊所）的电子健康记录数据。样本包括456名年龄16至24岁、于2025年1月至3月间就诊且有免疫接种史记录的患者。按诊所类型以及人口统计学和SDOH变量（包括年龄、性别、种族、族裔、参保状态、母语、初级保健提供者、HPV和破伤风疫苗接种状态以及合并症）分析乙型肝炎全程疫苗接种完成情况。在20家诊所中，422名患者（92.5%）完成了乙型肝炎全程疫苗接种。不同诊所类型的完成率存在显著差异（p=0.012）。性别、种族和族裔等人口统计学因素与接种状态无显著关联（p=0.092、p=0.787、p=0.956）。然而，年龄较小的患者更可能完成全程疫苗接种（p<0.001）。与享有公共或私人保险的患者相比，无保险患者的完成率较低（p=0.045）。其他常规疫苗（HPV系列/破伤风）的完成与乙型肝炎疫苗接种完成高度相关（所有p<0.001）。是否有初级保健提供者与完成情况无显著关联（p=0.271），HIV感染等合并症也未显示显著关联（p=0.092、p=0.124）。本队列的乙型肝炎疫苗接种率大幅高于全国平均水平。然而，基于各种SDOH因素的差异依然存在。结构性和可及性相关因素，尤其是诊所类型和保险覆盖，比人口统计学特征更能预测疫苗接种完成情况，提示在决定接种状态方面结构性因素的影响大于患者自身属性。这些发现凸显了需要采取系统层面的干预措施来支持全程接种完成，尤其针对服务不足的人群，以支持乙型肝炎预防并缓解癌症相关的差异。
查看英文原文 English abstract
Hepatitis B is a major cause of liver cancer in the United States and is also associated with increased risks of non-Hodgkin lymphoma, pancreatic, and head and neck cancers. Although the Hepatitis B vaccine is highly effective at preventing chronic infection and subsequent cancer development, vaccination rates remain low: In 2021, Hepatitis B vaccination coverage was 34.2% among adults 19 and older. This study evaluates Hepatitis B vaccination series completion among adolescents and young adults across clinic settings, demographics, and social determinants of health (SDOH) to identify gaps in vaccine coverage and reduce the incidence of Hepatitis B infection. We performed a retrospective, cross-sectional analysis using electronic health record data from adolescent medicine, pediatric infectious diseases, internal medicine-pediatrics, and family medicine clinics within the University of South Florida health system, and Ybor Youth Clinic, a community sexual health clinic within the USF pediatrics department. The sample included 456 patients aged 16-24 who were seen between January and March 2025 and had documented immunization histories. Completion of the Hepatitis B vaccination series was analyzed by clinic type and demographic and SDOH variables, including age, gender, race, ethnicity, insurance status, primary language, primary care provider, HPV and tetanus vaccination status, and comorbid conditions. Across 20 clinics, 422 patients (92.5%) completed the Hepatitis B vaccination series. Completion rates varied significantly across clinic types (p=0.012). Demographic factors such as gender, race, and ethnicity were not significantly associated with vaccination status (p=0.092, p=0.787, p=0.956). However, younger patients were more likely to have completed the vaccine series (p<0.001). Uninsured patients demonstrated lower completion rates compared to those with public or private insurance (p=0.045). Completion of other routine vaccines (HPV series/tetanus) was strongly correlated with Hepatitis B vaccination completion (all p<0.001). Having a primary care provider was not significantly linked to completion (p=0.271), and comorbidities such as HIV infection showed no significant association (p=0.092, p=0.124). Hepatitis B vaccination rates in this cohort were substantially higher than national averages. However, disparities persisted based on various SDOH factors. Structural and access-related factors, particularly clinic type and insurance coverage, were more predictive of vaccine completion than demographic characteristics, suggesting structural factors have a greater influence than patient attributes in determining vaccination status. These findings highlight the need for system-level interventions to support series completion, particularly among underserved populations, to support Hepatitis B prevention and mitigate cancer-related disparities.
利益披露 Disclosure
A. Vidwans, None..
A. Narkhede, None..
L. Sanders, None.