title: Hepatitis B vaccination coverage rates among adults in rural China: are economic barriers relevant?
abstract: BACKGROUND
  Hepatitis B virus (HBV) infections cause major health problems in China. The Expanded Program of Immunization has succeeded in reducing infection rates among infants and children, but HBV vaccination coverage rates among adults remain low.
  
  
  OBJECTIVE
  The objective was to investigate how individual adult HBV vaccination decisions are influenced by economic factors, socioeconomic status, and demographic characteristics, and to assess how potential vaccination policies could affect HBV vaccination coverage rates among adults.
  
  
  METHODS
  We interviewed 22,618 adults, aged 15-59 years, from 7948 households, in 45 villages from 7 provinces. A questionnaire was used to collect information. The actual vaccine status was modeled using a polychotomous logistic regression with three outcomes; unvaccinated, partial vaccination, and complete vaccination. A subsample of unvaccinated adults gave responses to a hypothetical vaccination policy that offered HBV vaccination free of charge and various amounts of money to compensate for direct and indirect vaccination-related costs.
  
  
  RESULTS
  The polychotomous logistic regression results suggest that vaccination user fees, time needed to get a vaccination, and vaccination-related travel costs were negatively associated with HBV vaccination coverage rates. Higher income was associated with higher coverage rates, and coverage rates decrease with age, with no significant difference between the genders. In the subsample that responded to the hypothetical policy, 55-72% (depending on the amount of money offered as compensation) stated they would accept a vaccination if it was offered free of charge.
  
  
  CONCLUSIONS
  Our polychotomous logistic regression results suggest that higher HBV vaccination coverage rates among adults are obtainable and that user fees, time needed to get a vaccination, and travel costs have acted as economic barriers to vaccination. This is supported by the responses to the hypothetical policy, which suggest that adult coverage rates could surge if HBV vaccine is offered at no cost.
authors.affiliation: Center for Health Management and Policy, Shandong University, Jinan, China. Electronic address: sduzdw@gmail.com.
authors.forename: Dawei
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Center for Health Management and Policy, Shandong University, Jinan, China. Electronic address: wangjiannan@sdu.edu.cn.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Health Management and Health Economics, University of Oslo, Oslo, Norway. Electronic address: k.r.wangen@medisin.uio.no.
authors.forename: Knut Reidar
authors.initials: KR
authors.lastname: Wangen
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D005260:Female; D006509:Hepatitis B / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D017325:Hepatitis B Vaccines
keywords: Adult vaccination; Economic barriers; Hepatitis B vaccines; Immunization; Socioeconomic status; Vaccination coverage