Lu Peng-Jun, O'Halloran Alissa, Ding Helen, Srivastav Anup, Williams Walter W
Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Ga.
Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Ga; Leidos Inc, Atlanta, Ga.
Am J Med. 2016 Jun;129(6):636.e1-636.e11. doi: 10.1016/j.amjmed.2015.10.031. Epub 2015 Nov 6.
Since 1960, the Advisory Committee on Immunization Practices has recommended influenza vaccination for adults with certain high-risk conditions because of increased risk for complications from influenza infection. We assessed national influenza vaccination among persons ages 18-64 years with high-risk conditions.
We analyzed data from the 2012 and 2013 National Health Interview Survey. The Kaplan-Meier survival analysis procedure was used to estimate the cumulative proportion of influenza vaccination among adults ages 18-64 years with high-risk conditions. Potential missed opportunities for influenza vaccination were also evaluated. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with vaccination.
Overall, 39.9 million adults ages 18-64 years (18.9%) had at least one high-risk condition. For adults ages 18-64 years with high-risk conditions, overall influenza vaccination coverage was 49.5%. Coverage among adults 50-64 years of age was significantly higher compared with those ages 18-49 years (59.3% vs 39.0%; P <.05). Among adults ages 18-64 years, coverage was 46.2% for those with chronic lung diseases, 50.5% for those with heart disease, 58.0% for those with diabetes, 62.5% for those with renal disease, and 56.4% for those with cancer. Overall, 90.1% reported at least one visit to a health care setting where vaccination could have been provided. Among adults ages 18-64 years with high-risk conditions, older age, being female, Hispanic ethnicity or Asian race, having one or more physician visits, a regular physician for health care, health insurance, and having ever received pneumococcal vaccination were independently associated with a higher likelihood of influenza vaccination. Being widowed/divorced/separated or never married and not being employed were independently associated with a lower likelihood of influenza vaccination.
Influenza vaccination coverage varies substantially by age and high-risk conditions but remains low. Approximately 50% of those with high-risk conditions remain unvaccinated. Health care providers should ensure they routinely assess influenza vaccination status, and recommend and offer vaccines to those with high-risk conditions.
自1960年以来，免疫实践咨询委员会建议患有某些高危疾病的成年人接种流感疫苗，因为流感感染引发并发症的风险增加。我们评估了18至64岁患有高危疾病人群的全国流感疫苗接种情况。
我们分析了2012年和2013年全国健康访谈调查的数据。采用Kaplan-Meier生存分析程序来估计18至64岁患有高危疾病成年人的流感疫苗接种累积比例。还评估了流感疫苗接种可能错过的机会。进行多变量逻辑回归和预测边际分析以确定与疫苗接种独立相关的因素。
总体而言，3990万18至64岁的成年人（18.9%）至少有一种高危疾病。对于18至64岁患有高危疾病的成年人，总体流感疫苗接种覆盖率为49.5%。50至64岁成年人的接种覆盖率显著高于18至49岁的成年人（59.3%对39.0%；P<.05）。在18至64岁的成年人中，慢性肺病患者的接种覆盖率为46.2%，心脏病患者为50.5%，糖尿病患者为58.0%，肾病患者为62.5%，癌症患者为56.4%。总体而言，90.1%的人报告至少去过一次可以接种疫苗的医疗机构。在18至64岁患有高危疾病的成年人中，年龄较大、女性、西班牙裔或亚裔、有一次或多次看医生经历、有固定的保健医生、有医疗保险以及曾接种过肺炎球菌疫苗与流感疫苗接种可能性较高独立相关。丧偶/离婚/分居或从未结婚以及未就业与流感疫苗接种可能性较低独立相关。
流感疫苗接种覆盖率因年龄和高危疾病情况差异很大，但仍然较低。约50%患有高危疾病的人仍未接种疫苗。医疗保健提供者应确保他们定期评估流感疫苗接种状况，并向患有高危疾病的人推荐并提供疫苗。
