Clinical Epidemiology Program, Veterans Affairs Medical Center, White River Junction, United States.
Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, United States.
Euro Surveill. 2020 May;25(19). doi: 10.2807/1560-7917.ES.2020.25.19.1900401.
IntroductionIt is unclear whether high-dose influenza vaccine (HD) is more effective at reducing mortality among seniors.AimThis study aimed to evaluate the relative vaccine effectiveness (rVE) of HD. MethodsWe linked electronic medical record databases in the Veterans Health Administration (VHA) and Medicare administrative files to examine the rVE of HD vs standard-dose influenza vaccines (SD) in preventing influenza/pneumonia-associated and cardiorespiratory mortality among VHA-enrolled veterans 65 years or older during the 2012/13, 2013/14 and 2014/15 influenza seasons. A multivariable Cox proportional hazards model was performed on matched recipients of HD vs SD, based on vaccination time, location, age, sex, ethnicity and VHA priority level. ResultsAmong 569,552 person-seasons of observation, 207,574 (36%) were HD recipients and 361,978 (64%) were SD recipients, predominantly male (99%) and white (82%). Pooling findings from all three seasons, the adjusted rVE estimate of HD vs SD during the high influenza periods was 42% (95% confidence interval (CI): 24-59) against influenza/pneumonia-associated mortality and 27% (95% CI: 23-32) against cardiorespiratory mortality. Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10-62) and 25% (95% CI: 12-38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. These were confirmed by results from two-stage residual inclusion estimations.DiscussionThe HD was associated with a lower risk of influenza/pneumonia-associated and cardiorespiratory death in men during the high influenza period.
引言
目前尚不清楚高剂量流感疫苗（HD）是否能更有效地降低老年人的死亡率。
目的
本研究旨在评估 HD 相对于标准剂量流感疫苗（SD）的相对疫苗有效性（rVE）。
方法
我们将退伍军人事务部（VA）电子病历数据库和医疗保险行政文件进行链接，以检查在 2012/13、2013/14 和 2014/15 流感季节期间，65 岁及以上 VA 登记退伍军人中，HD 与 SD 预防流感/肺炎相关和心肺死亡的 rVE。根据接种时间、地点、年龄、性别、种族和 VA 优先级，对接受 HD 与 SD 的匹配接受者进行多变量 Cox 比例风险模型分析。
结果
在 569552 人年的观察中，207574 人（36%）为 HD 接受者，361978 人（64%）为 SD 接受者，主要为男性（99%）和白人（82%）。合并所有三个季节的研究结果，在高流感期间，HD 与 SD 相比，调整后的 rVE 估计值为 42%（95%置信区间（CI）：24-59），与流感/肺炎相关的死亡率相关，为 27%（95%CI：23-32）与心肺死亡率相关。尽管进行了匹配和多变量调整，但在早期和晚期流感期间仍存在残余混杂。在基线时排除高 1 年预计死亡率的个体可减少残余混杂，并产生 rVE 为 36%（95%CI：10-62）和 25%（95%CI：12-38），分别与流感/肺炎相关和心肺死亡率相关。这两项结果都通过两阶段剩余纳入估计得到了证实。
讨论
在高流感期间，男性使用 HD 与较低的流感/肺炎相关和心肺死亡风险相关。
