Chang Yu-Chia, Yu-Tung Huang, Chen Long-Sheng, Tung Ho-Jui, Huang Kuang-Hua, Ernawaty Ernawaty, Wu Szu-Yuan
Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan.
Department of Medical Research, China Medical University, Taichung 40402, Taiwan.
Vaccines (Basel). 2020 Mar 22;8(1):140. doi: 10.3390/vaccines8010140.
This is the first and largest population-based cohort study to demonstrate that influenza vaccination reduced all-cause mortality and influenza-related hospitalization in elderly individuals with a disability.
To estimate the protective effect of influenza vaccination in elderly individuals with a disability by conducting a propensity score-matched (PSM), nationwide, population-based cohort study.
Data from Taiwan's National Health Insurance Research Database were used in this study. Generalized estimating equations (GEEs) were used to compare outcomes between the vaccinated and unvaccinated cohorts. The GEE logit was used to estimate the relative risks of death and hospitalization after influenza vaccination. Adjusted odds ratios (aORs) were used to estimate relative risk.
The matching process yielded a final cohort of 272 896 elderly individuals with a disability (136 448 individuals in each cohort). In multivariate GEE analyses, aOR (vaccinated vs. unvaccinated) and 95% confidence interval (CI) of death were 0.70 (0.68-0.72). The aORs (95% CIs) of hospitalization for influenza and pneumonia, respiratory diseases, respiratory failure, heart disease, hemorrhagic stroke, and ischemic stroke were 0.98 (0.95-1.01), 0.96 (0.94-0.99), 0.85 (0.82-0.89), 0.96 (0.93-0.99), 0.85 (0.75-0.97), and 0.89 (0.84-0.95), respectively. The length of stay and medical expenditure exhibited greater reduction in vaccinated elderly individuals with a severe and very severe disability than in unvaccinated elderly individuals.
Influenza vaccination reduced all-cause mortality, influenza-related hospitalization, length of stay, and medical expenditure in elderly individuals with a disability. The decrease in the length of stay and medical expenditure because of influenza vaccination was proportional to the severity of disability.
这是第一项也是规模最大的基于人群的队列研究，旨在证明流感疫苗接种可降低残疾老年人的全因死亡率和与流感相关的住院率。
通过开展一项倾向得分匹配（PSM）的全国性基于人群的队列研究，评估流感疫苗接种对残疾老年人的保护作用。
本研究使用了台湾国民健康保险研究数据库的数据。采用广义估计方程（GEEs）比较接种组和未接种组的结局。GEE逻辑回归用于估计流感疫苗接种后死亡和住院的相对风险。调整后的优势比（aORs）用于估计相对风险。
匹配过程产生了一个由272896名残疾老年人组成的最终队列（每个队列136448人）。在多变量GEE分析中，死亡的aOR（接种组与未接种组）及95%置信区间（CI）为0.70（0.68 - 0.72）。流感和肺炎、呼吸系统疾病、呼吸衰竭、心脏病、出血性中风和缺血性中风住院的aOR（95%CI）分别为0.98（0.95 - 1.01）、0.96（0.94 - 0.99）、0.85（0.82 - 0.89）、0.96（0.93 - 0.99）、0.85（0.75 - 0.97）和0.89（0.84 - 0.95）。与未接种疫苗的残疾老年人相比，接种疫苗的重度和极重度残疾老年人的住院时间和医疗费用减少幅度更大。
流感疫苗接种降低了残疾老年人的全因死亡率、与流感相关的住院率、住院时间和医疗费用。因流感疫苗接种导致的住院时间和医疗费用的减少与残疾严重程度成正比。
