Walzer Pauline, Estève Clémentine, Barben Jeremy, Menu Didier, Cuenot Christine, Manckoundia Patrick, Putot Alain
Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, CEDEX, 21079 Dijon, France.
Infectious Diseases Department, University Hospital, CEDEX, 21079 Dijon, France.
Vaccines (Basel). 2020 Jul 3;8(3):356. doi: 10.3390/vaccines8030356.
Influenza remains a major cause of illness and death in geriatric populations. While the influenza vaccine has successfully reduced morbidity and mortality, its effectiveness is suspected to decrease with age. The aim of this study was to assess the impact of influenza vaccination on all-cause mortality in very old ambulatory subjects. We conducted a prospective cohort study from 1 July 2016 to 31 June 2017 in a large unselected ambulatory population aged over 80 years. We compared all-cause mortality in vaccinated versus unvaccinated subjects after propensity-score matching, to control for age, sex and comorbidities. Among the 9149 patients included, with mean age 86 years, 4380 (47.9%) were vaccinated against influenza. In total, 5253 (57.4%) had at least one chronic disease. The most commonly vaccinated patients were those with chronic respiratory failure (76.3%) and the least commonly vaccinated were those suffering from Parkinson's disease (28.5%). Overall, 2084 patients (22.8%) died during the study. After propensity score matching, the mortality was evaluated at 20.9% in the vaccinated group and 23.9% in the unvaccinated group (OR = 0.84 [0.75-0.93], = 0.001). This decrease in mortality in the vaccinated group persisted whatever the age and Charlson Comorbidity index. In conclusion, nearly a half of this ambulatory elderly population received Influenza vaccine. After adjustment on comorbidities, influenza vaccination was associated with a significant decrease in all-cause mortality, even in the eldest multimorbid population. Improving immunization coverage in this frail older population is urgently needed.
流感仍然是老年人群患病和死亡的主要原因。虽然流感疫苗已成功降低了发病率和死亡率，但其有效性被怀疑会随着年龄增长而下降。本研究的目的是评估流感疫苗接种对高龄非卧床患者全因死亡率的影响。我们于2016年7月1日至2017年6月31日在一个未经过筛选的80岁以上大型非卧床人群中进行了一项前瞻性队列研究。我们在倾向得分匹配后比较了接种疫苗组和未接种疫苗组的全因死亡率，以控制年龄、性别和合并症因素。在纳入的9149例患者中，平均年龄86岁，4380例（47.9%）接种了流感疫苗。总共有5253例（57.4%）患有至少一种慢性病。接种疫苗最普遍的患者是患有慢性呼吸衰竭的患者（76.3%），接种疫苗最不普遍的是患有帕金森病的患者（28.5%）。总体而言，2084例患者（22.8%）在研究期间死亡。倾向得分匹配后，接种疫苗组的死亡率评估为20.9%，未接种疫苗组为23.9%（OR = 0.84 [0.75 - 0.93]，P = 0.001）。无论年龄和查尔森合并症指数如何，接种疫苗组的死亡率下降情况持续存在。总之，近一半的非卧床老年人群接种了流感疫苗。在调整合并症后，流感疫苗接种与全因死亡率显著降低相关，即使在年龄最大、患有多种疾病的人群中也是如此。迫切需要提高这一脆弱老年人群的免疫接种覆盖率。
