de Diego Cinta, Vila-Córcoles Angel, Ochoa Olga, Rodriguez-Blanco Teresa, Salsench Elisabeth, Hospital Imma, Bejarano Ferran, Del Puy Muniain M, Fortin Mercé, Canals Montserrat
Primary Care Service of Tarragona-Valls, Institut Català de la Salut, Prat de la Riba 39, Tarragona 43001, Catalonia, Spain.
Eur Heart J. 2009 Jan;30(2):209-16. doi: 10.1093/eurheartj/ehn498. Epub 2008 Nov 8.
Although there is general agreement for the recommendation of the influenza vaccine to elderly and high-risk adults, the magnitude of clinical effectiveness and benefit from the annual vaccination is controversial. In this study, we have assessed the effects of annual influenza vaccination on winter mortality in older adults with chronic heart disease.
Cohort study that included 1340 Spanish community-dwelling individuals 65 years or older who had chronic heart disease (congestive heart failure or coronary artery disease) followed from January 2002 to April 2005. Annual influenza vaccine status was a time-varying condition and primary outcome was all-cause death during the study period. Multivariable Cox proportional-hazard models adjusted by age, sex, and comorbidity were used to evaluate vaccine effectiveness. Influenza vaccination was associated with a significant reduction of 37% in the adjusted risk of winter mortality during the overall period 2002-2005. The attributable mortality risk reduction in vaccinated people was 8.2 deaths per 1000 person-winters. We estimated that one death was prevented for every 122 annual vaccinations (ranging between 49 in Winter 2005 and 455 in Winter 2003).
Our results suggest a benefit from the influenza vaccination and support an annual vaccination strategy for elderly people with cardiac diseases.
尽管对于向老年人和高危成年人推荐流感疫苗已达成普遍共识，但每年接种疫苗的临床效果和益处的程度仍存在争议。在本研究中，我们评估了每年接种流感疫苗对患有慢性心脏病的老年人冬季死亡率的影响。
队列研究，纳入了1340名年龄在65岁及以上、患有慢性心脏病（充血性心力衰竭或冠状动脉疾病）的西班牙社区居民，研究时间为2002年1月至2005年4月。每年的流感疫苗接种状况是一个随时间变化的条件，主要结局是研究期间的全因死亡。使用经年龄、性别和合并症调整的多变量Cox比例风险模型来评估疫苗效果。在2002 - 2005年整个期间，流感疫苗接种与冬季死亡率调整风险显著降低37%相关。接种疫苗人群中可归因的死亡风险降低为每1000人 - 冬季8.2例死亡。我们估计每122次年度接种可预防1例死亡（范围在2005年冬季的49例至2003年冬季的455例之间）。
我们的结果表明流感疫苗接种有益，并支持对患有心脏病的老年人采取每年接种疫苗的策略。
