Department of Applied Economics, Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Tinbergen Institute, Rotterdam, The Netherlands.
Eur J Public Health. 2020 Apr 1;30(2):275-280. doi: 10.1093/eurpub/ckaa016.
Our objective was to obtain estimates of the impact of the Dutch vaccination programme on medication use, outpatient visits, hospitalization and mortality at age 65.
We linked population-wide mortality, hospitalization and municipality registries to identify influenza-related deaths and hospitalizations, and used health interview surveys to identify medication use and outpatient visits during 1996-2008. We applied a regression discontinuity design to estimate the intention-to-treat effect of the personal invitation for a free influenza vaccination sent to every Dutch inhabitant at age 65 years on each of the outcomes, separately in influenza-epidemic and non-epidemic months.
Invitation receipt for free influenza vaccination at age 65 led to a 9.8 percentage points [95% confidence interval (CI) = 3.5 to16.1; P < 0.01] rise in influenza vaccination. During influenza-epidemic months, it was associated with 1.5 fewer influenza/pneumonia deaths per 100 000 individuals (95% CI = -3.1 to -0.0; P = 0.05), a 15 percentage point lower probability to use prescribed medicines (95% CI = -28 to -3; P = 0.02) and 0.13 fewer General Practitioner (GP) visits per month (95% CI = -0.28 to 0.02; P = 0.09), while the association with hospitalizations due to influenza/pneumonia was small and imprecisely estimated (seven more hospitalizations per 100 000 individuals, 95% CI = -20 to 33; P = 0.63). No associations were found with any outcomes during non-epidemic months.
Personal invitations for a free influenza vaccination sent to every Dutch inhabitant at age 65 took pressure off primary health care but had small effects on hospitalizations and mortality.
我们的目的是评估荷兰免疫计划对 65 岁人群药物使用、门诊就诊、住院和死亡率的影响。
我们将人群死亡率、住院和市政登记处的数据进行了关联，以确定与流感相关的死亡和住院情况，并使用健康访谈调查来确定 1996 年至 2008 年期间的药物使用和门诊就诊情况。我们采用回归间断设计，单独在流感流行和非流行月份，估计每位 65 岁荷兰居民收到个人免费流感疫苗接种邀请的意向治疗效果对每种结局的影响。
在 65 岁时收到免费流感疫苗接种邀请，会使流感疫苗接种率提高 9.8 个百分点（95%置信区间[CI] = 3.5 至 16.1；P < 0.01）。在流感流行月份，它与每 10 万人中减少 1.5 例流感/肺炎死亡相关（95%CI = -3.1 至 -0.0；P = 0.05），使用处方药的可能性降低 15 个百分点（95%CI = -28 至 -3；P = 0.02），每月全科医生（GP）就诊次数减少 0.13 次（95%CI = -0.28 至 0.02；P = 0.09），而与流感/肺炎住院相关的关联则较小且估计不精确（每 10 万人中增加 7 例住院，95%CI = -20 至 33；P = 0.63）。在非流行月份，未发现与任何结局相关的关联。
向每位 65 岁荷兰居民发送个人免费流感疫苗接种邀请，减轻了初级保健的压力，但对住院和死亡率的影响较小。
