Vercelli M, Lillini R, Arata L, Zangrillo F, Bagnasco A, Sasso L, Magliani A, Gasparini R, Amicizia D, Panatto D
Department of Health Sciences (DISSAL), University of Genoa, Italy.
Analytical Epidemiology & Health Impact, Fondazione IRCCS "Istituto Nazionale Tumori", Milan, Italy.
J Prev Med Hyg. 2019 Feb 28;59(4 Suppl 2):E11-E17. doi: 10.15167/2421-4248/jpmh2018.59.4s2.1171. eCollection 2018 Dec.
The elderly suffer the most influenza-related complications, and 90% of deaths due to influenza occur in older subjects. Consequently, the elderly are among the main targets of influenza vaccination campaigns. The use of deprivation indexes can help to identify subgroups with lower vaccination uptake. This study analyzed influenza vaccination coverage in elderly persons living in Genoa (Italy) in relation to a local Index of Socio-Economic and Health Deprivation (SEHDI) in order to identify population subgroups needing specific intervention to improve vaccination coverage.
The study targeted subjects aged ≥ 65 years living in Genoa in the period 2009-2013. Information on vaccination coverage was provided by general practitioners and Local Health Units. A combination of linear regression, factor analysis and cluster analysis was used to construct the SEHDI at Census Tract (CT) level, on the basis of data from the 2011 Italian census.
In 2011, people aged ≥ 65 years accounted for the 27.7% of the population of Genoa. Most elderly subjects were assigned to either the medium (45.3%) or medium-high (32%) deprivation groups, while the percentages in the extreme tails were low (3.6% high deprivation; 1.3% low deprivation). Significant, non-linear (p < 0.05 NL) relationships were observed in both sexes with regard to mortality due to all respiratory diseases (RD) and chronic obstructive pulmonary disease (COPD), with the highest Standardized Mortality Ratio (SMR) values in women in the high deprivation group of women (1.81, p < 0.05 RD; 1.79, p < 0.05 COPD). The SMRs for influenza and pneumonia showed a positive linear trend in women (p < 0.05) with the highest value in the high deprivation group (1.97, p < 0.05), while in men the trend was NL (p < 0.05). A positive linear trend (p < 0.05) was found with regard to vaccination coverage, which grew weakly as deprivation increased, up to the medium-high deprived group (from 34.6% to 44.4%). However, the high deprivation group showed the lowest value (33.3%).
The results revealed a relationship between deprivation and influenza vaccination coverage in the elderly. This finding should be taken into account in the organization of vaccination campaigns and should prompt differentiated intervention in each local area.
老年人患流感相关并发症的情况最为严重，90%的流感致死病例发生在老年人群体中。因此，老年人是流感疫苗接种运动的主要目标人群之一。使用贫困指数有助于识别疫苗接种率较低的亚组。本研究分析了居住在意大利热那亚的老年人的流感疫苗接种覆盖率与当地社会经济和健康贫困指数（SEHDI）之间的关系，以确定需要采取特定干预措施来提高疫苗接种覆盖率的人群亚组。
该研究针对2009 - 2013年期间居住在热那亚的65岁及以上的老年人。疫苗接种覆盖率信息由全科医生和当地卫生单位提供。基于2011年意大利人口普查数据，采用线性回归、因子分析和聚类分析相结合的方法，在普查小区（CT）层面构建SEHDI。
2011年，65岁及以上的人群占热那亚总人口的27.7%。大多数老年受试者被归入中等贫困组（45.3%）或中等偏高贫困组（32%），而处于极端贫困组的比例较低（高贫困组为3.6%；低贫困组为1.3%）。在所有呼吸道疾病（RD）和慢性阻塞性肺疾病（COPD）导致的死亡率方面，两性均观察到显著的非线性关系（p < 0.05 NL），女性高贫困组的标准化死亡率（SMR）值最高（RD为1.81，p < 0.05；COPD为1.79，p < 0.05）。流感和肺炎的SMR在女性中呈正线性趋势（p < 0.05），高贫困组的值最高（1.97，p < 0.05），而在男性中趋势为非线性（p < 0.05）。在疫苗接种覆盖率方面发现了正线性趋势（p < 0.05），随着贫困程度的增加，覆盖率微弱上升，直至中等偏高贫困组（从34.6%升至44.4%）。然而，高贫困组的覆盖率最低（33.3%）。
研究结果揭示了贫困与老年人流感疫苗接种覆盖率之间的关系。这一发现应在疫苗接种运动的组织中予以考虑，并应促使在每个地区采取差异化干预措施。
