乳幼児期における適切な時期の予防接種行動に関連した個人レベルおよび地域レベル要因の検討  [in Japanese] Association between time-appropriate vaccinations in early childhood and individual and community-level factors in Japan  [in Japanese]

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Author(s)

    • 大澤 絵里 OSAWA Eri
    • 国立保健医療科学院国際協力研究部|東邦大学大学院医学研究科社会医学講座衛生学分野 Department of International Health and Collaboration, National Institute of Public Health|Department of Environmental and Occupational Health, Toho University Graduate School of Medicine
    • 秋山 有佳 AKIYAMA Yuka
    • 山梨大学大学院総合研究部医学域社会医学講座 Department of Health Sciences, Graduate School Department of Interdisciplinary Research, University of Yamanashi
    • 尾島 俊之 OJIMA Toshiyuki
    • 浜松医科大学医学部健康社会医学講座 Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
    • 今村 晴彦 IMAMURA Haruhiko
    • 東邦大学大学院医学研究科社会医学講座衛生学分野|東邦大学医学部社会医学講座衛生学分野 Department of Environmental and Occupational Health, Toho University Graduate School of Medicine|Department of Environmental and Occupational Health, School of Medicine, Toho University
    • 朝倉 敬子 ASAKURA Keiko
    • 東邦大学大学院医学研究科社会医学講座衛生学分野|東邦大学医学部社会医学講座衛生学分野 Department of Environmental and Occupational Health, Toho University Graduate School of Medicine|Department of Environmental and Occupational Health, School of Medicine, Toho University
    • 西脇 祐司 NISHIWAKI Yuji
    • 東邦大学大学院医学研究科社会医学講座衛生学分野|東邦大学医学部社会医学講座衛生学分野 Department of Environmental and Occupational Health, Toho University Graduate School of Medicine|Department of Environmental and Occupational Health, School of Medicine, Toho University
    • 大岡 忠生 OOKA Tadao
    • 山梨大学大学院総合研究部医学域社会医学講座 Department of Health Sciences, Graduate School Department of Interdisciplinary Research, University of Yamanashi
    • 山縣 然太朗 YAMAGATA Zentaro
    • 山梨大学大学院総合研究部医学域社会医学講座 Department of Health Sciences, Graduate School Department of Interdisciplinary Research, University of Yamanashi

Abstract

<p><b>目的</b> 日本での乳幼児の予防接種は,個別接種化,種類や回数の増加により,接種スケジュールが複雑化している。本研究では,目的変数である乳幼児の適切な時期の予防接種行動と,かかりつけ医の有無,社会経済状態など(個人レベル要因)および小児科医師数など(地域レベル要因)の関連を明らかにする。</p><p><b>方法</b> 本研究は,「健やか親子21」最終評価の一環として,1歳6か月児健診時に保護者および市町村(特別区・政令市も含む,以下市町村)を対象に行われた調査,市町村別医師数などの既存調査のデータを用いた分析である。本研究で必要な変数がすべて揃った430市町村23,583人を分析対象とした。分析はBCG, DPT,麻疹の予防接種の適切な時期での接種を目的変数として,個人レベル変数(かかりつけ医の有無,社会経済的状況など)を投入したモデル1,地域レベル変数(市町村の小児科医師数など)をいれたモデル2,モデル2に市町村の取り組みに関する変数をいれたモデル3として,マルチレベル・ロジスティック回帰分析を行った。</p><p><b>結果</b> 88.3%の保護者が,適切な時期に乳幼児の予防接種行動をとっていた。かかりつけ医がいない(オッズ比[95%信頼区間],0.45[0.36-0.55]),第2子以降(第4子以降で0.23[0.19-0.28]等),母親の出産時年齢が29歳以下(19歳以下で0.17[0.13-0.24]等),母親が就労(常勤で0.52[0.47-0.58]等),経済状況が苦しい(大変苦しいで0.66[0.57-0.77]等)者では,適切な時期に予防接種行動をとる者が少なかった。地域レベルの要因では,市町村の小児科医師数四分位最大群(15歳未満人口1,000人対),15歳未満人口1,000人対の診療所数,予防接種率向上の取り組み,かかりつけ医確保の取り組みは,適切な時期の予防接種行動に関連していなかった。市町村の予防接種情報の利活用は,適切な時期の予防接種の完了と負の関連がみられた(0.84[0.73-0.96])。</p><p><b>結論</b> 乳幼児期にかかりつけ医をもたないこと,若年の母親,出生順位が遅いこと,経済的困難,母親の就労が,複数の予防接種の不十分な接種との関連要因であった。乳幼児の予防接種において,不十分な接種のリスクがある家庭への特別な配慮と,乳幼児がかかりつけ医をもつことができるような環境整備が必要である。</p>

<p><b>Objective</b> Recently, in Japan, the compulsory vaccinations administered during early childhood have been becoming increasingly varied. As a result, the vaccination schedule has become complicated. In this study, we aimed to identify the association of time-appropriate vaccination during early childhood (dependent variable) with individual-level factors including socioeconomic status and having a family doctor. We also studied the association of time-appropriate vaccination with community-level factors including the number of pediatricians in a community.</p><p><b>Methods</b> Multilevel logistic regression models were used for analysis. Time-appropriate BCG, DPT, and measles vaccinations were the dependent variables. Individual-level data were obtained through a survey of parents of 18-month-old children as part of the final evaluation of "Healthy Parents and Children 21"; community-level data were obtained through a survey of municipalities as part of the aforementioned final evaluation as well as through a national survey. There were 23,583 parents in 430 municipalities who were eligible for analysis.</p><p><b>Results</b> Time-appropriate vaccination of infants was carried out by 88.3% of parents. The results of the multilevel logistic regression showed that time-appropriate vaccination was significantly lower for those who did not have a family doctor (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.36-0.55), the fourth or later birth order (0.23; 0.19-0.28), mothers aged less than 19 years at childbirth (0.17; 0.13-0.24), full-time working mothers (0.52; 0.47-0.58), and those under very difficult economic conditions (0.66; 0.57-0.77). Among community-level factors, only use of vaccination data by a municipality had a significantly negative association with the dependent variable.</p><p><b>Conclusion</b> Not having a family doctor, the mother's young age, late birth order, poor economic status, and full-time working mothers were risk factors associated with delayed vaccinations. It is necessary to improve environments that promote infants having a family doctor as well as to promote special approaches toward families at risk for delayed vaccinations.</p>

Journal

  • Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH)

    Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH) 66(2), 67-75, 2019

    Japanese Society of Public Health

Codes

  • NII Article ID (NAID)
    130007604494
  • NII NACSIS-CAT ID (NCID)
    AN00189323
  • Text Lang
    JPN
  • ISSN
    0546-1766
  • NDL Article ID
    029526840
  • NDL Call No.
    Z19-216
  • Data Source
    NDL  J-STAGE 
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