Vaccination coverage trends in European Union from 1980 to 2020: A joinpoint Regression Analysis

Abstract   Vaccinations are successful, cost-effective public health interventions; nevertheless, vaccine hesitancy represents a concern and several EU countries have implemented mandatory vaccinations to counteract it. The assessment of vaccination coverage data is helpful to clarify the reason behind this choice better and assess its impact. Data were extracted from the WUENIC database as of July 2021. All the 27 EU countries were included, considering the period from 1980 to 2020 (depending on data availability). Coverage indicators on seven vaccinations scheduled during the first year of life to prevent nine vaccine-preventable diseases were considered. Joinpoint regression was run using Joinpoint Trend Analysis Software 4.9.0.0. For each coverage indicator, the last two trends in time identified by the joinpoint regression were considered to identify countries with a positive vaccination coverage trend (having either the last trend significantly positive or the second last significantly negative but followed by a trend reversal) or a negative coverage trend (having either the last trend significantly negative or the second last significantly positive but followed by a trend reversal). To assess each country, we collated together information on each coverage indicator. A total of 180 jointpoint regressions were run. At least one joinpoint was observed in 144 cases: 39 (27.1%) showed a significant positive trend, and 49 (34%) had a significantly negative one. In 36 cases, there was a single trend lacking a joinpoint, either positive (21, 58.3%), negative (8, 22.2%), or not showing a change (7, 19.4%). Overall, 14 countries had mostly negative vaccination coverage trends, whereas 13 had mostly positive vaccination coverage trends. Systematised data collection and analysis of vaccination coverage trends are needed to support public health systems. EU countries differ broadly, but the overall situation shows that coverage trends are a key issue to be addressed. Key messages • Vaccination coverage in the EU shows a general negative trend. The assessment and comparison of coverage trends across EU countries could make policymakers able to respond to critical issues timely. • Mandatory vaccinations have been issued in different countries to prevent vaccination coverages from decreasing. Some countries have not issued any mandate but show high vaccination coverages.


Background:
Cervical screening is one of the most important tools to reduce the incidence and mortality of cervical cancer, but uptake is still insufficient in many European countries with implemented population screening programs. In this study, we analyze the sociodemographic characteristics of women who do not attend cervical screening and describe the barriers that these women may have to attend cervical screening using Czechia as an example.

Methods:
In the representative sample of 902 Czech women, we first employed binary logistic regression to identify groups of women that have higher chances of being non-attendees. Second, we described the reasons non-attendees declared as barriers to attendance. Third, we analyzed whether there were differences in women's characteristics according to the declared barriers.

Results:
In the study sample, 36.7% of the women were considered non-attendees. Women with lower education (primary compared to university education, OR = 2.2, 95%CI 1.2-3.9) single women (compared to married/partnered, OR = 3.6, 95%CI 2.0-5.1), or older women, had a higher chance of not attending the screening. The most frequently declared reasons for not attending were 'not experiencing any symptoms' (36.3%), 'fear of cancer diagnosis' (23.0%), and 'fear of the examination procedure' (20.2%). In most of these barriers, women declaring these reasons did not differ from the other nonattendees.

Conclusions:
Identifying sociodemographic determinants of cervical screening non-attendance and the barriers women have to attend are crucial for improving cervical cancer prevention. Based on this knowledge, public health policies should minimize screening hesitancy by targeting psychological factors and improving screening literacy among women. Although this research is a case study for Czechia, we believe that the results may be applicable in other countries.
Vaccinations are successful, cost-effective public health interventions; nevertheless, vaccine hesitancy represents a concern and several EU countries have implemented mandatory vaccinations to counteract it. The assessment of vaccination coverage data is helpful to clarify the reason behind this choice better and assess its impact. Data were extracted from the WUENIC database as of July 2021. All the 27 EU countries were included, considering the period from 1980 to 2020 (depending on data availability). Coverage indicators on seven vaccinations scheduled during the first year of life to prevent nine vaccine-preventable diseases were considered. Joinpoint regression was run using Joinpoint Trend Analysis Software iii124 European Journal of Public Health, Volume 32 Supplement 3, 2022 4.9.0.0. For each coverage indicator, the last two trends in time identified by the joinpoint regression were considered to identify countries with a positive vaccination coverage trend (having either the last trend significantly positive or the second last significantly negative but followed by a trend reversal) or a negative coverage trend (having either the last trend significantly negative or the second last significantly positive but followed by a trend reversal). To assess each country, we collated together information on each coverage indicator. A total of 180 jointpoint regressions were run. At least one joinpoint was observed in 144 cases: 39 (27.1%) showed a significant positive trend, and 49 (34%) had a significantly negative one. In 36 cases, there was a single trend lacking a joinpoint, either positive (21, 58.3%), negative (8, 22.2%), or not showing a change (7, 19.4%). Overall, 14 countries had mostly negative vaccination coverage trends, whereas 13 had mostly positive vaccination coverage trends. Systematised data collection and analysis of vaccination coverage trends are needed to support public health systems. EU countries differ broadly, but the overall situation shows that coverage trends are a key issue to be addressed.

Key messages:
Vaccination coverage in the EU shows a general negative trend. The assessment and comparison of coverage trends across EU countries could make policymakers able to respond to critical issues timely.

Background:
Menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity. The aim of this study was to assess menstrual inequity and its associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain.

Methods:
A cross-sectional online survey-based study was conducted in Spain in March-July 2021. Data were analysed through descriptive statistical analyses and multivariate logistic regression models.

Background:
Previous studies point to the importance of individuals' sense of community belonging to multiple measures of health and well-being. However, the extent to which collective sense of belonging within neighbourhoods might influence individual health has not been characterized. The objectives of this study are to describe variations in self-rated health by a novel arealevel measure of community belonging and determine the impact of including these measures in models of individuallevel community belonging and self-rated health.

Methods:
We conducted a cross-sectional study of respondents of the 2020 Canadian Community Health Survey (CCHS) living in census tracts. These data were merged with novel small area estimates of community belonging derived by Statistics Canada from the CCHS 2016-2019. Multinomial logistic regression models were used to analyse associations of individual-and area-level community belonging, and self-rated health. We adjusted for sex, age, recent immigrant status, visible minority status, province, marital status, presence of children in the household, smoking status, presence of chronic conditions, income, and employment status. All results were generated using survey weights and bootstraps representing a subpopulation of 21 million people.

Results:
A greater proportion of CCHS respondents living in neighbourhoods with the strongest collective sense of community belonging reported being in good, very good, or excellent health. Models indicate that living in a neighbourhood with low collective sense of community belonging is associated with higher odds of reporting being in poor or fair health (OR = 1.44, 95% CI 1.15-1.81) even after adjusting for other factors, including individual-level sense of community belonging, which also remained independently associated with self-rated health.

Conclusions:
Both area-and individual-level sense of community belonging are independently associated with self-rated health.

Key messages:
The collective sense of belonging within neighbourhoods may influence health outcomes.
Measures of area-level and individual-level community belonging may capture different aspects of social connections with respect to health.