接种流感疫苗对中小学生缺课预防效果实证研究

李武; 刘兰兰; 谭惠玲; 蒋亚文; 陈婉宜; 庄春燕; 谢媛娜; 谢旭; 李刚

doi:10.16835/j.cnki.1000-9817.2024376

接种流感疫苗对中小学生缺课预防效果实证研究

doi: 10.16835/j.cnki.1000-9817.2024376

李武¹,
刘兰兰²,
谭惠玲^1, ,,
蒋亚文³,
陈婉宜¹,
庄春燕¹,
谢媛娜¹,
谢旭⁴,
李刚^1, ,

1.
广东省深圳市龙岗区疾病预防控制中心免疫规划管理科， 518172
2.
国家感染性疾病临床医学研究中心/深圳市第三人民医院(南方科技大学第二附属医院)临床研究项目管理办公室
3.
中山大学公共卫生学院(深圳)
4.
深圳市疾病预防控制中心免疫规划所

基金项目:

深圳市龙岗区科技创新专项资金医疗卫生技术攻关项目 LGKCYLWS2023033

详细信息

作者简介:
李武(1990-)，男，湖南邵阳人，硕士，主管医师，主要研究方向为疫苗可预防疾病监测和效果评估

通讯作者:
谭惠玲，E-mail: 987178534@qq.com

李刚，E-mail: 302960666@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R186 R373.1⁺³ R181.3⁺²
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- 被引次数: 0
出版历程
- 收稿日期: 2024-10-15
- 修回日期: 2024-11-06
- 网络出版日期: 2025-01-07
- 刊出日期: 2024-12-25

An empirical study on the effect of influenza vaccination on the prevention of school absence among primary and secondary school students

1.
Department of Immunization Programme Management, Shenzhen Longgang Center for Disease Control and Prevention, Shenzhen (518172), Guangdong Province, China

摘要

摘要: 目的评估实施流感疫苗免费接种政策对中小学生缺课的预防效果，为制定和调整接种策略提供参考。方法根据深圳市龙岗区6~18岁中小学生在2023年11月是否接种流感疫苗分为接种组(265 996名)和未接种组(122 513名)，采用倾向性评分匹配对两组进行1∶1匹配以平衡协变量，以学生每月缺课次数为因变量构建双重差分模型，采用Poisson回归对总体和多时点效果进行分析。结果接种流感疫苗可降低中小学生缺课的发生风险，对缺课的总体预防效果为26.52%(95%CI=23.47%~29.45%)；2023年11(接种当月)和12月、2024年1月和3月的预防效果分别为42.12%，40.12%，30.33%，20.91%。接种流感疫苗对小学生的缺课预防效果(26.39%)与对中学生的缺课预防效果(27.97%)差异无统计学意义(P>0.05)；班级接种率的回归系数介于0.998~0.999(P值均 < 0.01)，即流感疫苗接种率每提高10%可降低1.5%~2.2%的缺课率。结论开展中小学生免费流感疫苗接种可降低缺课的发生风险，具有良好社会经济学效益。
- 流感疫苗 /
- 接种 /
- 缺勤 /
- 回归分析 /
- 学生
Abstract: Objective To evaluate the preventive effect of implementing the free influenza vaccination policy on school absence among primary and secondary school students, so as to provide a reference for formulating and adjusting vaccination strategies. Methods Among primary and secondary school students aged 6 to 18 in Longgang District, Shenzhen, they were divided into a vaccinated group (265 996 students) and an unvaccinated group (122 513 students) according to their influenza vaccination history during November 2023. Propensity score matching was used to conduct a 1∶1 match between the two groups to balance covariates. The number of absences per month was set as the dependent variable to construct a difference-in-differences model, and Poisson regression was employed to analyze the overall and multi-time-point effects. Results Vaccination against influenza was associated with low rate of absenteeism among primary and secondary school students, with an overall preventive effect of 26.52% (95%CI=23.47%-29.45%). The preventive effects in November (the month of vaccination) and December 2023, January and March 2024 were 42.12%, 40.12%, 30.33% and 20.91%, respectively. The preventive effect of the influenza vaccine on absenteeism among primary school students (26.39%) was not significantly different from that among secondary school students (27.97%) (P>0.05). The regression coefficient for class vaccination rates ranged from 0.998 to 0.999 (P < 0.01), indicating that for every 10% increase in influenza vaccination rates, absenteeism could be reduced by 1.5% to 2.2%. Conclusion Implementing free influenza vaccination for primary and secondary school students might help to reduce the risk of absenteeism, yielding significant socioeconomic benefits.
- Influenza vaccines /
- Vaccination /
- Absenteeism /
- Regression analysis /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 中小学生接种和未接种InfV组平均缺课率变化趋势

注：平均缺课率=(各时期缺课人次数/各时期的观察人月数)×100%

Figure 1. Trends of the average absenteeism rate between vaccinated and unvaccinated InfV groups of primary and secondary school students

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表 1 PSM前后接种组与未接种组不同特征分布比较

Table 1. Comparison of the distribution of different characteristics between the vaccinated and non-vaccinated groups before and after PSM

组别	选项	PSM前				PSM后
组别	选项	接种组 (n=265 996)	未接种组 (n=122 513)	χ²值	P值	接种组 (n=62 467)	未接种组 (n=62 467)	χ²值	P值
年龄/岁	6~11	149 283(56.1)	67 243(54.9)	51.93	< 0.01	39 688(63.5)	39 637(63.5)	0.09	0.76
	12~18	116 713(43.9)	55 270(45.1)			22 779(36.5)	22 830(36.5)
性别	男	142 815(53.7)	68 457(55.9)	161.67	< 0.01	34 990(56.0)	35 011(56.0)	0.01	0.91
	女	123 181(46.3)	54 056(44.1)			27 477(44.0)	27 456(44.0)
民族	汉族	256 453(96.4)	118 025(96.3)	1.38	0.24	60 260(96.5)	60 177(96.3)	1.59	0.21
	其他	9 543(3.6)	4 488(3.7)			2 207(3.5)	2 290(3.7)
上年度接种	未接种	59 597(22.4)	55 655(45.4)	21 308.24	< 0.01	25 301(40.5)	25 298(40.5)	0.00	0.99
InfV	已接种	206 399(77.6)	66 858(54.6)			37 166(59.5)	37 169(59.5)
上年度报告	未发病	250 654(94.2)	116 184(94.8)	57.67	< 0.01	58 509(93.7)	58 501(93.7)	0.00	0.92
流感	已发病	15 342(5.8)	6 329(5.2)			3 958(6.3)	3 966(6.3)
注：其他民族指少数民族和境外户籍人员，()内数字为构成比/%。

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表 2 中小学生接种InfV对缺课影响的DID回归分析[IRR值(95%CI)]

Table 2. DID regression analysis of the effect of InfV on absenteeism among primary and secondary school students[IRR(95%CI)]

自变量	中小学生(n=124 934)		小学生(n=90 752)		中学生(n=34 182)
自变量	基准DID模型	多时点DID模型	基准DID模型	多时点DID模型	基准DID模型	多时点DID模型
Time	1.24(1.20~1.28)^**	—	1.27(1.23~1.32)^**	—	1.08(1.00~1.17)	—
Group	0.88(0.84~0.93)^**	0.85(0.82~0.89)^**	0.89(0.85~0.94)^**	0.87(0.84~0.91)^**	0.84(0.74~0.94)^**	0.78(0.70~0.87)^**
Time×Group	0.74(0.71~0.77)^**	—	0.74(0.70~0.77)^**	—	0.72(0.65~0.80)^**	—
pre₃	—	1.03(0.97~1.10)	—	0.99(0.92~1.06)	—	1.20(1.05~1.36)^**
pre₂	—	1.44(1.36~1.52)^**	—	1.47(1.38~1.57)^**	—	1.30(1.14~1.47)^**
current	—	2.28(2.16~2.41)^**	—	2.30(2.16~2.45)^**	—	2.20(1.95~2.48)^**
post₁	—	1.86(1.75~1.96)^**	—	1.94(1.82~2.07)^**	—	1.48(1.31~1.67)^**
post₂	—	1.46(1.37~1.56)^**	—	1.48(1.37~1.60)^**	—	1.39(1.20~1.61)^**
post₃	—	1.55(1.46~1.64)^**	—	1.59(1.49~1.69)^**	—	1.38(1.22~1.56)^**
post₄	—	1.10(1.03~1.17)^**	—	1.15(1.08~1.23)^**	—	0.87(0.76~1.01)
post₅	—	1.16(1.09~1.24)^**	—	1.24(1.16~1.33)^**	—	0.82(0.70~0.96)^*
post₆	—	0.61(0.55~0.67)^**	—	0.60(0.54~0.66)^**	—	0.66(0.52~0.85)^**
pre₃×Group	—	1.06(1.00~1.14)	—	1.05(0.98~1.13)	—	1.10(0.94~1.29)
pre₂×Group	—	1.03(0.96~1.09)	—	1.02(0.95~1.09)	—	1.08(0.94~1.25)
current×Group	—	0.58(0.55~0.61)^**	—	0.59(0.55~0.62)^**	—	0.54(0.47~0.63)^**
post₁×Group	—	0.60(0.56~0.64)^**	—	0.60(0.56~0.65)^**	—	0.57(0.48~0.68)^**
post₂×Group	—	0.70(0.65~0.75)^**	—	0.71(0.65~0.77)^**	—	0.65(0.54~0.78)^**
post₃×Group	—	0.79(0.75~0.84)^**	—	0.80(0.75~0.85)^**	—	0.75(0.65~0.87)^**
post₄×Group	—	0.98(0.92~1.04)	—	0.96(0.89~1.03)	—	1.09(0.92~1.28)
post₅×Group	—	1.01(0.95~1.07)	—	0.98(0.92~1.05)	—	1.16(0.98~1.36)
post₆×Group	—	1.03(0.99~1.17)	—	1.08(0.96~1.22)	—	1.34(0.98~1.83)
注：^P<0.05，^P < 0.01；自变量中，Time为时间虚拟变量，Group为分组虚拟变量，pre_2-3为2023年9月和2023年10月的时期虚拟变量，current为InfV接种时期(2023年11月)时间虚拟变量，post*_1-6表示InfV接种后的2023年12月、2024年1月、2024年3月、2024年4月、2024年5月、2024年6月的时期虚拟变量。

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