Objective To quantify changes in inequalities in uptake of childhood vaccination during a period of steadily declining overall childhood vaccination rates in England. Design Longitudinal study. Setting General practice data for five vaccines administered to children (first and second doses of the measles, mumps, and rubella vaccine (MMR1 and MMR2, respectively), rotavirus vaccine, pneumococcal conjugate vaccine (PCV) booster, and six-in-one (DTaP/IPV/Hib/HepB) vaccine covering diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, and hepatitis B) from the Cover of Vaccination Uptake Evaluated Rapidly dataset in England. Participants Children aged <5 years eligible for vaccinations between April 2019 and March 2023 registered at primary care practices in England. 2 386 317 (2 309 674 for rotavirus vaccine) children included in the study were eligible at age 1 year, 2 456 020 at 2 years, and 2 689 304 at 5 years. Main outcome measures Changes in quarterly vaccine uptake over time and compared by deprivation level. Regression analyses were used to quantify the change in inequalities in vaccine uptake over time—expressed as changes in the slope index of inequality (SII). Cumulative susceptibility to measles and rotavirus disease at age 5 years was estimated. Analyses were repeated at regional level. Results The absolute inequality in vaccine uptake at baseline (2019-20) was largest for MMR2 in children at age 5 years (SII −9.6%, 95% confidence interval (CI) −10.2% to −9.0%). For all vaccinations studied, the SII for uptake increased over the study period: from −5.1% to −7.7% for the six-in-one vaccine, −7.4% to −10.2% for rotavirus, −7.9% to −9.7% for PCV booster, −8.0% to −10.0% for MMR1 at age 2 years, −3.1% to −5.6% for MMR1 at age 5 years, and −9.6% to −13.4% for MMR2 at age 5 years. The number of children susceptible to measles by the end of the study period increased 15-fold in the least deprived group (from 1364 to 20 958) and 20-fold in the most deprived group (from 1296 to 25 345). For rotavirus, a 14-fold increase was observed in the least deprived group (from 2292 to 32 981) and a 16-fold increase in the most deprived group (from 2815 to 45 201). Regional analysis showed greatest inequalities in uptake in London and the northern regions. Conclusion The findings of this study suggest that inequalities in childhood vaccination are increasing in England, as uptake rates for five key childhood vaccinations decreased between 2019 and 2023, below the World Health Organization’s recommended 95% uptake target, and with noticeable regional differences. Urgent action is needed to strengthen systems for childhood vaccination, with a key focus on reducing inequalities. All data are open access and available through original sources at the UK Health Security Agency () and the Office for Health Improvement and Disparities (. R code, step by step guides, and data for analysis are available at [https://github.com/danhungi/Vaccine\_SII\_England][1]). [1]: https://github.com/danhungi/Vaccine_SII_England

中文翻译：

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2019-23 年英格兰儿童疫苗接种率的不平等：纵向研究


目的 量化在英格兰整体儿童疫苗接种率稳步下降期间儿童疫苗接种率不平等的变化。设计 纵向研究。设置五种儿童疫苗（麻疹、腮腺炎和风疹疫苗的第一剂和第二剂（分别为 MMR1 和 MMR2）、轮状病毒疫苗、肺炎球菌结合疫苗 （PCV） 加强剂和六合一 （DTaP/IPV/Hib/HepB） 疫苗的全科实践数据，涵盖英格兰的快速疫苗接种数据集。参与者 年龄为 <5 岁的儿童在 2019 年 4 月至 2023 年 3 月期间有资格接种疫苗，并在英格兰的初级保健诊所注册。2 386 317 名（轮状病毒疫苗为 2 309 674 名）纳入研究的儿童在 1 岁时符合条件，2 456 020 名在 2 岁时符合 2 689 304 岁条件。主要结局指标 季度疫苗接种率随时间的变化和按剥夺水平进行比较。回归分析用于量化疫苗接种率不平等随时间的变化——表示为不平等斜率指数 （SII） 的变化。估计 5 岁时对麻疹和轮状病毒病的累积易感性。在区域层面重复分析。结果 基线 （2019-20） 时 MMR2 疫苗接种的绝对不平等在 5 岁儿童中最大 （SII -9.6%，95% 置信区间 （CI） -10.2% 至 -9.0%）。对于所研究的所有疫苗接种，接种率的 SII 在研究期间有所增加：六合一疫苗从 -5.1% 增加到 -7.7%，轮状病毒从 -7.4% 增加到 -10.2%，PCV 加强针从 -7.9% 增加到 -9.7%，2 岁时 MMR1 从 -8.0% 增加到 -10.0%，5 岁时 MMR1 从 -3.1% 增加到 -5.6%，以及 -9。5 岁时 MMR2 为 6%-13.4%。到研究期结束时，最贫困群体易患麻疹的儿童人数增加了 15 倍（从 1364 人增加到 20 958 人），最贫困群体增加了 20 倍（从 1296 人增加到 25 345 人）。对于轮状病毒，在最不贫困的群体中观察到增加了 14 倍（从 2292 到 32 981），在最贫困的群体中观察到增加了 16 倍（从 2815 增加到 45 201）。区域分析显示，伦敦和北部地区的接种率存在最大的不平等。结论本研究的结果表明，英格兰儿童疫苗接种的不平等现象正在加剧，因为 2019 年至 2023 年期间五种关键儿童疫苗接种的接种率下降，低于世界卫生组织推荐的 95% 接种目标，并且存在明显的地区差异。需要采取紧急行动加强儿童疫苗接种系统，重点是减少不平等。所有数据都是开放获取的，可通过英国卫生安全局 （） 和健康改善和差异办公室 （.R 代码、分步指南和分析数据可在 [https://github.com/danhungi/Vaccine\_SII\_England][1]） 中找到。[1]：https://github。com/danhungi/Vaccine_SII_England