Hepatitis B vaccination coverage in patients with diabetes mellitus

Cross-sectional study, conducted in a health unit in a city in the state of São Paulo, with 255 patients on outpatient follow-up, in 2014. Data were obtained from the computerized system of the Municipal Health Department and via a structured questionnaire. A logistic regression model was used for analysis.

RESULTS

Full hepatitis B vaccination was noted in 13.7% of the patients and shown to be directly associated with their educational level (OR=1.30; CI: 1.07-1.57) and current or previous work as a health professional (OR=3.21; CI: 1.16-8.89).

CONCLUSION

Hepatitis B vaccination coverage was found to be low in patients with diabetes mellitus, indicating their vulnerability to this serious and potentially fatal disease. Higher educational level and working in the field of health were associated with better vaccination coverage.

Descriptors:
Hepatitis B; Immunization Coverage; Diabetes Mellitus; Educational Status; Health Personnel

Variables	n	%
Gender
Male	85	33.3
Female	170	66.7
Age
≤ 49 years	35	13.8
> 49 years	220	86.2
Education
None	9	3.5
Adult literacy	2	0.8
1^st - 4^th Incomplete elementary education	51	20.0
1^st - 4^th Complete elementary education	69	27.1
5^th - 8^th Incomplete secondary education	26	10.2
5^th - 8^th Complete secondary education	31	12.2
Incomplete high school	8	3.1
Complete high school	39	15.3
Incomplete higher education	10	3.9
Complete higher education	10	3.9
Length of time with diabetes (years)
<1	9	3.5
1-10	129	50.6
11-20	71	27.8
21-30	35	13.7
31-40	10	3.9
51-60	1	0.4
Insulin use
Yes	150	58.8
No	105	41.2
Blood glucose monitoring
Yes	190	74.5
No	65	25.5
Health professional
Yes	25	9.8
No	230	90.2
Police officer/corrections officer/jailer
Yes	5	1.6
No	250	98.4
Residential/hospital trash collection worker
Yes	8	3.1
No	247	96.9
Manicurist/pedicurist/podiatrist
Yes	12	4.7
No	243	95.3
Risk behavior ^a a Current or past sexual or domestic contact with individuals with hepatitis B, having smoked, inhaled or injected drugs, having a history of sexually communicable diseases and blood or blood product transfusions.
Yes	197	77.3
No	58	22.7

Reported doses	Registered doses
	No record		1 or 2 (incomplete)		≥ 3 (complete)		Total
	n	%	n	%	n	%	n	%
None	80	96.4	1	1.2	2	2.4	83	100
1 or 2	1	10.0	5	50.0	4	40.0	10	100
≥ 3	10	31.3	2	6.2	20	62.5	32	100
Does not know number of doses	20	69.0	2	6.9	7	24.1	29	100
Does know if was vaccinated	97	96.0	0	0.0	4	4.0	101	100
Total	208	81.6	12	4.7	35	13.7	255	100

Variables	Registered doses
	< 3 ^a a Patients with one, two or no doses registered.		≥ 3		p^b b Pearson chi-square test (gender, insulin use, blood glucose monitoring, health professional, risk behavior; Fisher's exact test (Police officer/corrections officer/jailer; Residential/hospital trash collection worker; Manicurist/pedicurist/podiatrist), Wilcoxon-Mann-Whitney test (Age, education, length of time with DM).	OR (CI 95%)
	n	%	n	%
Gender
Male	74	87.1	11	12.9		1.00
Female	146	85.9	24	14.1	0.797	1.10 (0.51-2.38)
Age
Median (p25-p75)	64 (57-71)		60 (47-65)		0.003	-
≤ 49 years	23	65.7	12	34.3
> 49 years	197	89.5	23	10.5
Education
None	9	100.0	0	0.0
Adult literacy	1	50.0	1	50.0
1^st - 4^th Incomplete elementary	47	92.2	4	7.8
1^st - 4^th Complete elementary	64	92.8	5	7.2
5^th - 8^th Incomplete secondary	24	92.3	2	7.7
5^th - 8^th Complete secondary	28	90.3	3	9.7
Incomplete high school	5	62.5	3	37.5
Complete high school	28	71.8	11	28.2
Incomplete higher education	8	80.0	2	20.0
Complete higher education	6	60.0	4	40.0	<0.001	-
Length of time with diabetes
<1	7	77.8	2	22.2
1-10	113	87.6	16	12.4
11-20	59	83.1	12	16.9
21-30	30	85.7	5	14.3
31-40	10	100.0	0	0.0
51-60	1	100.0	0	0.0	0.865	-
Insulin use
No	94	89.5	11	10.5		1.00
Yes	126	84.0	24	16.0	0.207	1.62 (0.75-3.48)
Blood glucose monitoring					0.207	1.62 (0.75-3.48)
No	60	92.3	5	7.7		1.00
Yes	160	84.2	30	15.8	0.102	2.25 (0.83-6.06)
Health professional
No	204	88.7	26	11.3		1.00
Yes	16	64.0	9	36.0	0.001	4.41 (1.77-10.99)
Police officer/corrections officer/jailer					0.001	4.41 (1.77-10.99)
No	216	86.4	34	13.6		1.00
Yes	4	80.0	1	20.0	0.683	1.58 (0.17-14.6)
Residential/hospital trash collection worker					0.683	1.58 (0.17-14.6)
No	212	85.8	35	14.2
Yes	8	100.0	0	0.0	0.604	-
Manicurist/pedicurist/podiatrist					0.604	-
No	210	86.4	33	13.6		1.00
Yes	10	83.3	2	16.7	0.762	1.27 (0.26-6.06)
Risk behavior^c c Current or past sexual or domestic contact with individuals with hepatitis B, having smoked, inhaled or injected drugs, having a history of sexually communicable diseases and blood or blood product transfusions.					0.762	1.27 (0.26-6.06)
No	170	86.3	27	13.7		1.00
Yes	50	86.2	8	13.8	0.986	1.00 (0.43-2.35)

Variables	OR (CI 95%)	p	Standard error
Female	1.45 (0.61-3.41)	0.391	0.63
Age	0.97 (0.93-1.01)	0.175	0.01
Education	1.26 (1.03-1.53)	0.020	0.12
Length of time with DM	0.99 (0.94-1.04)	0.809	0.02
Insulin use	11.1 (0.38-3.21)	0.846	0.60
Blood glucose monitoring	1.56 (0.43-5.61)	0.489	1.02
Health professional	3.21 (1.16-8.89)	0.024	1.66

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Clarissa Cordeiro Alves Arrelias. Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo. Avenida Bandeirantes, 3900 - Campus Universitário. CEP 14040-902 - Ribeirão Preto, SP, Brazil. claarrelias@usp.br