Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
Division of General Medicine, Michigan Medicine, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800, USA.
Vaccine. 2018 Jun 14;36(25):3635-3640. doi: 10.1016/j.vaccine.2018.05.021. Epub 2018 May 7.
Patients with chronic conditions have higher rates of severe influenza-related illness and mortality. However, influenza vaccination coverage in high-risk populations continues to be suboptimal. We describe the association between cumulative disease morbidity, measured by a previously validated multimorbidity index, and influenza vaccination among community-dwelling adults.
We obtained interview and medical record data for participants ≥18 years who sought outpatient care for influenza-like illness between 2011 and 2016 as part of an outpatient-based study of influenza vaccine effectiveness. We defined cumulative disease morbidity by using medical diagnosis codes to calculate a multimorbidity-weighted index (MWI) for each participant. MWI and influenza vaccination status was evaluated by logistic regression. Akaike information criterion was calculated for all models.
Overall, 1458 (48%) of participants out of a total of 3033 received influenza vaccination. The median MWI was 0.9 (IQR 0.00-3.5) and was higher among vaccinated participants (median 1.6 versus 0.0; p < 0.001). We found a positive linear association between MWI and vaccination, and vaccination percentages were compared between categories of MWI. Compared to patients with no multimorbidity (MWI = 0), odds of vaccination were 17% higher in the second category (MWI 0.01-1.50; [OR: 1.17, 95% CI: 0.92-1.50]), 58% higher in the third category (MWI 1.51-3.00; [OR: 1.58, 95% CI: 1.26-1.99]), 130% higher in the fourth category (MWI 3.01-6.00; [OR: 2.30, 95% CI: 1.78-2.98]) and 214% higher in the fifth category (MWI 6.01-45.00;[OR: 3.14, 95% CI: 2.41-4.10]). Participants defined as high-risk had 86% greater odds of being vaccinated than non-high-risk individuals (OR: 1.86, 95% CI: 1.56-2.21). The AIC was lowest for MWI compared with high-risk conditions.
Our results suggest a dose response relationship between level of multimorbidity and likelihood of influenza vaccination. Compared with high-risk condition designations, MWI provided improved precision and a better model fit for the measurement of chronic disease and influenza vaccination.
慢性病患者患严重流感相关疾病和死亡的风险更高。然而，高危人群的流感疫苗接种率仍然不理想。我们描述了累积疾病发病率与社区居住成年人流感疫苗接种之间的关系，累积疾病发病率通过使用医疗诊断代码计算每个参与者的多疾病加权指数（MWI）来衡量。
我们获得了 2011 年至 2016 年期间因流感样疾病在门诊接受治疗的参与者的访谈和病历数据，这些参与者年龄均在 18 岁以上，作为流感疫苗有效性的基于门诊的研究的一部分。我们通过使用医疗诊断代码为每个参与者计算多疾病加权指数（MWI）来定义累积疾病发病率。使用逻辑回归评估 MWI 和流感疫苗接种状况。为所有模型计算了 Akaike 信息准则。
总体而言，在总共 3033 名参与者中，有 1458 名（48%）接受了流感疫苗接种。MWI 的中位数为 0.9（IQR 0.00-3.5），接种疫苗的参与者更高（中位数 1.6 与 0.0；p<0.001）。我们发现 MWI 与接种疫苗之间呈正线性关系，并且比较了 MWI 各分类中的接种疫苗百分比。与无多种疾病（MWI=0）的患者相比，MWI 为 0.01-1.50 的第二类患者的接种疫苗几率高 17%（比值比：1.17，95%置信区间：0.92-1.50），MWI 为 1.51-3.00 的第三类患者的接种疫苗几率高 58%（比值比：1.58，95%置信区间：1.26-1.99），MWI 为 3.01-6.00 的第四类患者的接种疫苗几率高 130%（比值比：2.30，95%置信区间：1.78-2.98），MWI 为 6.01-45.00 的第五类患者的接种疫苗几率高 214%（比值比：3.14，95%置信区间：2.41-4.10）。被定义为高危的参与者比非高危个体更有可能接种疫苗，几率高 86%（比值比：1.86，95%置信区间：1.56-2.21）。与高危条件相比，MWI 的 AIC 最低。
我们的结果表明，多种疾病的严重程度与流感疫苗接种的可能性之间存在剂量反应关系。与高危条件指定相比，MWI 为慢性疾病和流感疫苗接种的测量提供了更高的精度和更好的模型拟合度。
