Conscientious vaccination exemptions in kindergarten to eighth-grade children across Texas schools from 2012 to 2018: A regression analysis.,PLOS Medicine

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Conscientious vaccination exemptions in kindergarten to eighth-grade children across Texas schools from 2012 to 2018: A regression analysis.
PLOS Medicine ( IF 10.5 ) Pub Date : 2020-03-10 , DOI: 10.1371/journal.pmed.1003049
Maike Morrison ₁ , Lauren A Castro _{1,

2} , Lauren Ancel Meyers _{1,

3}

Affiliation

Background

As conscientious vaccination exemption (CVE) percentages rise across the United States, so does the risk and occurrence of outbreaks of vaccine-preventable diseases such as measles. In the state of Texas, the median CVE percentage across school systems more than doubled between 2012 and 2018. During this period, the proportion of schools surpassing a CVE percentage of 3% rose from 2% to 6% for public schools, 20% to 26% for private schools, and 17% to 22% for charter schools. The aim of this study was to investigate this phenomenon at a fine scale.

Methods and findings

Here, we use beta regression models to study the socioeconomic and geographic drivers of CVE trends in Texas. Using annual counts of CVEs at the school system level from the 2012–2013 to the 2017–2018 school year, we identified county-level predictors of median CVE percentage among public, private, and charter schools, the proportion of schools below a high-risk threshold for vaccination coverage, and five-year trends in CVEs. Since the 2012–2013 school year, CVE percentages have increased in 41 out of 46 counties in the top 10 metropolitan areas of Texas. We find that 77.6% of the variation in CVE percentages across metropolitan counties is explained by median income, the proportion of the population that holds a bachelor's degree, the proportion of the population that self-reports as ethnically white, the proportion of the population that is English speaking, and the proportion of the population that is under the age of five years old. Across the 10 top metropolitan areas in Texas, counties vary considerably in the proportion of school systems reporting CVE percentages above 3%. Sixty-six percent of that variation is explained by the proportion of the population that holds a bachelor’s degree and the proportion of the population affiliated with a religious congregation. Three of the largest metropolitan areas—Austin, Dallas–Fort Worth, and Houston—are potential vaccination exemption "hotspots," with over 13% of local school systems above this risk threshold. The major limitations of this study are inconsistent school-system-level CVE reporting during the study period and a lack of geographic and socioeconomic data for individual private schools.

Conclusions

In this study, we have identified high-risk communities that are typically obscured in county-level risk assessments and found that public schools, like private schools, are exhibiting predictable increases in vaccination exemption percentages. As public health agencies confront the reemerging threat of measles and other vaccine-preventable diseases, findings such as ours can guide targeted interventions and surveillance within schools, cities, counties, and sociodemographic subgroups.

中文翻译：

2012 年至 2018 年德克萨斯州学校幼儿园至八年级儿童的认真疫苗接种豁免：回归分析。

背景

随着美国各地良性疫苗接种豁免 (CVE) 百分比的上升，麻疹等疫苗可预防疾病爆发的风险和发生率也在上升。在德克萨斯州，2012 年至 2018 年间，整个学校系统的 CVE 百分比中位数增加了一倍多。在此期间，CVE 百分比超过 3% 的学校比例从公立学校的 2% 上升到 6%，公立学校从 20% 上升到 2%。私立学校为 26%，特许学校为 17% 至 22%。本研究的目的是在精细范围内调查这一现象。

方法和结果

在这里，我们使用 beta 回归模型来研究德克萨斯州 CVE 趋势的社会经济和地理驱动因素。利用 2012-2013 年至 2017-2018 学年学校系统层面的年度 CVE 计数，我们确定了公立、私立和特许学校中 CVE 百分比的县级预测因子，即低于高中的学校比例。疫苗接种覆盖率的风险阈值以及 CVE 的五年趋势。自 2012-2013 学年以来，德克萨斯州前 10 大都市区的 46 个县中有 41 个县的 CVE 百分比有所上升。我们发现，大都市县之间 77.6% 的 CVE 百分比差异可以通过收入中位数、拥有学士学位的人口比例、自称白人的人口比例、白人的人口比例来解释。是英语国家，以及五岁以下人口的比例。在德克萨斯州 10 个顶级大都市区中，各县报告 CVE 百分比高于 3% 的学校系统比例差异很大。百分之六十六的差异是由拥有学士学位的人口比例和加入宗教团体的人口比例来解释的。三个最大的都市区——奥斯汀、达拉斯-沃斯堡和休斯顿——是潜在的疫苗接种豁免“热点”，超过 13% 的当地学校系统高于这一风险阈值。这项研究的主要局限性是研究期间学校系统层面的 CVE 报告不一致，以及缺乏个别私立学校的地理和社会经济数据。