Division of Geriatrics, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China.
J Gerontol A Biol Sci Med Sci. 2013 Mar;68(3):324-30. doi: 10.1093/gerona/gls175. Epub 2012 Sep 11.
The efficacy of influenza vaccination in older nursing home residents is frequently overestimated due to frailty selection bias. Limited data exist to examine this issue.
We conducted a prospective cohort study from December 2009 to November 2010 to evaluate the efficacy of influenza vaccination in old nursing home residents with respect to their functional status. Participants were stratified according to the Barthel Index (BI) into good functioning (GF; BI > 60), intermediate functioning (IF; BI = 5-60), and poor functioning (PF; BI = 0). Participants were vaccinated by monovalent H1N1 2009 and trivalent seasonal influenza vaccinations (H1N1-TIV), TIV alone, or remained unvaccinated by choice. The associations between all-cause mortality, vaccination efficacy, and functional status were examined.
A total of 711 older nursing home residents were enrolled (GF group: N = 230; IF group: N = 246; PF group: N = 235). At 12 months, H1N1-TIV recipients had the lowest all-cause mortality, whereas unvaccinated residents had the highest all-cause mortality in all three functional status groups. In the comparison between H1N1-TIV recipients and TIV alone recipients, the hazard ratios (HRs) of all-cause mortality were lower in the GF group and higher in the PF group (GF group: HR 0.30 [0.07-0.95], p < .05; IF group: HR 0.40 [0.18-0.86], p < .05; PF group: HR 0.53 [0.28-0.99], p < .05). The same observation was found in comparison between other vaccination statuses (H1N1-TIV vs unvaccinated and TIV alone vs unvaccinated).
Influenza vaccination was associated with reduced all-cause mortality in older nursing home residents with different functional statuses. Vaccine efficacy in reducing mortality declined with increasingly impaired functional status.
由于衰弱选择偏倚，老年人在养老院的流感疫苗接种效果经常被高估。目前关于这个问题的研究数据有限。
我们进行了一项前瞻性队列研究，于 2009 年 12 月至 2010 年 11 月期间，评估了不同功能状态的老年养老院居民接种流感疫苗的效果。根据巴氏量表（BI），将参与者分为功能良好（BI>60）、中等功能（BI=5-60）和功能差（BI=0）三组。参与者接受了单价 H1N1 2009 疫苗和三价季节性流感疫苗（H1N1-TIV）、单独 TIV 或选择不接种疫苗。观察了全因死亡率、疫苗接种效果和功能状态之间的关系。
共纳入 711 名老年养老院居民（功能良好组：N=230；中等功能组：N=246；功能差组：N=235）。在 12 个月时，H1N1-TIV 组的全因死亡率最低，而在所有三组功能状态中，未接种疫苗的居民的全因死亡率最高。在 H1N1-TIV 组和单独 TIV 组之间的比较中，GF 组和 PF 组的全因死亡率的 HR 较低（GF 组：HR 0.30[0.07-0.95]，p<.05；IF 组：HR 0.40[0.18-0.86]，p<.05；PF 组：HR 0.53[0.28-0.99]，p<.05）。在其他疫苗接种状态（H1N1-TIV 与未接种疫苗、单独 TIV 与未接种疫苗）之间的比较中也观察到了同样的结果。
流感疫苗接种与不同功能状态的养老院老年人全因死亡率降低相关。疫苗降低死亡率的效果随着功能状态的恶化而下降。
