Loiacono Matthew M, Mahmud Salaheddin M, Chit Ayman, van Aalst Robertus, Kwong Jeffrey C, Mitsakakis Nicholas, Skinner Luke, Thommes Edward, Bricout Hélène, Grootendorst Paul
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada.
College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada.
Vaccine X. 2020 Jan 13;4:100054. doi: 10.1016/j.jvacx.2020.100054. eCollection 2020 Apr 9.
We sought to gain insights into the determinants of seasonal influenza vaccine (SIV) uptake by conducting an age-stratified analysis (18-64 and 65+) of factors associated with SIV uptake among at-risk adults registered to English practices. Records for at-risk English adults between 2011 and 2016 were identified using the Clinical Practice Research Datalink database. SIV uptake was assessed annually. The associations of patient, practice, and seasonal characteristics with SIV uptake were assessed via cross-sectional and longitudinal analyses, using mixed-effects and general estimating equation logistic regression models. Overall SIV uptake was 35.3% and 74.0% for adults 18-64 and 65+, respectively. Relative to white patients, black patients were least likely to be vaccinated (OR: 0.82 (95% CI: 0.80, 0.85); OR: 0.59 (95% CI: 0.56, 0.62)), while Asian patients among 18-64 year olds were most likely to be vaccinated (OR: 1.10 (95% CI: 1.07, 1.13)). Females were more likely than males to be vaccinated among 18-64 year olds (OR: 1.19 (95% CI: 1.18, 1.20)). Greater socioeconomic deprivation was associated with decreased odds of uptake among older patients (OR: 0.74 (95% CI: 0.71, 0.77)). For each additional at-risk condition, odds of uptake increased (OR: 2.33 (95% CI: 2.31, 2.36); OR: 1.39 (95% CI: 1.38, 1.39)). Odds of uptake were highest among younger patients with diabetes (OR: 4.25 (95% CI: 4.18, 4.32)) and older patients with chronic respiratory disease (OR: 1.60 (95% CI: 1.58, 1.63)), whereas they were lowest among morbidly obese patients of all ages (OR: 0.68 (95% CI: 0.67, 0.70); OR: 0.97 (95% CI: 0.94, 0.99)). Prior influenza season severity and vaccine effectiveness were marginally predictive of uptake. Our age-stratified analysis uncovered SIV uptake disparities by ethnicity, sex, age, socioeconomic deprivation, and co-morbidities, warranting further attention by GPs and policymakers alike.
我们通过对在英国医疗机构登记的高危成年人中与季节性流感疫苗（SIV）接种相关的因素进行年龄分层分析（18 - 64岁和65岁及以上），试图深入了解SIV接种的决定因素。使用临床实践研究数据链数据库识别了2011年至2016年期间英国高危成年人的记录。每年评估SIV接种情况。通过横断面和纵向分析，使用混合效应和广义估计方程逻辑回归模型评估患者、医疗机构和季节特征与SIV接种之间的关联。18 - 64岁和65岁及以上成年人的总体SIV接种率分别为35.3%和74.0%。与白人患者相比，黑人患者接种疫苗的可能性最小（OR：0.82（95%CI：0.80，0.85）；OR：0.59（95%CI：0.56，0.62）），而18 - 64岁的亚洲患者接种疫苗的可能性最大（OR：1.10（95%CI：1.07，1.13））。在18 - 64岁的人群中，女性比男性更有可能接种疫苗（OR：1.19（95%CI：1.18，1.20））。社会经济剥夺程度越高，老年患者接种疫苗的几率越低（OR：0.74（95%CI：0.71，0.77））。每增加一种高危疾病，接种疫苗的几率就会增加（OR：2.33（95%CI：2.31，2.36）；OR：1.39（95%CI：1.38，1.39））。糖尿病年轻患者（OR：4.25（95%CI：4.18，4.32））和慢性呼吸道疾病老年患者（OR：1.60（95%CI：1.58，1.63））接种疫苗的几率最高，而各年龄段的病态肥胖患者接种疫苗几率最低（OR：0.68（95%CI：0.67，0.70）；OR：0.97（95%CI：0.94，0.99））。前一个流感季节的严重程度和疫苗效力对疫苗接种有一定的预测作用。我们的年龄分层分析发现，SIV接种在种族、性别、年龄、社会经济剥夺程度和合并症方面存在差异，值得全科医生和政策制定者进一步关注。
