Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany.
Pettenkoffer School of Public Health, Munich, Germany.
Ann Am Thorac Soc. 2022 Sep;19(9):1479-1488. doi: 10.1513/AnnalsATS.202112-1359OC.
Vaccination is the most effective protection against influenza. Patients with interstitial lung diseases (ILDs) represent a high-risk group for influenza complications. Thus, yearly influenza vaccination is recommended, but evidence on its effects is sparse. This study aimed to compare all-cause mortality and all-cause and respiratory-related hospitalization between vaccinated and unvaccinated patients with ILD. Using data from the largest German statutory health insurance fund (about 27 million insurees in 2020), we analyzed four influenza seasons from 2014-2015 to 2017-2018 and compared vaccinated with unvaccinated patients with ILD. Starting from September 1 of each year, we matched vaccinated and unvaccinated patients in a 1:1 ratio using a rolling cohort design. Mortality and hospitalization were compared with Kaplan-Meier plots, and effects were calculated during the influenza season (in season) with risk ratios. Both the vaccinated and the unvaccinated cohorts included 7,503 patients in 2014-2015, 10,318 in 2015-2016, 12,723 in 2016-2017, and 13,927 in 2017-2018. Vaccination rates were low at 43.2% in season 2014-2015 and decreased over time to 39.9% in season 2017-2018. The risk ratios for all-cause mortality were 0.79 (95% confidence interval [CI], 0.65-0.97; = 0.02) in season 2014-2015, 0.66 (95% CI, 0.54-0.80; < 0.001) in 2015-2016, 0.89 (95% CI, 0.76-1.04; = 0.15) in 2016-2017, and 0.95 (95% CI, 0.81-1.12; = 0.57) in 2017-2018. The effects on all-cause hospitalization and respiratory-related hospitalization were similar in all seasons. Although an unequivocally beneficial impact of influenza vaccination in patients with ILD could not be demonstrated, we observed promising results regarding avoidance of all-cause mortality in half of the seasons observed. Given the low vaccination rates, further efforts are necessary to improve vaccination rates in patients with ILD.
接种疫苗是预防流感最有效的方法。患有间质性肺疾病（ILDs）的患者是流感并发症的高危人群。因此，建议每年接种流感疫苗，但目前关于其效果的证据有限。本研究旨在比较接种和未接种流感疫苗的ILD 患者的全因死亡率以及全因和与呼吸相关的住院率。本研究使用了德国最大的法定健康保险基金的数据（2020 年约有 2700 万被保险人），分析了 2014-2015 年至 2017-2018 年四个流感季节，并比较了接种和未接种 ILD 疫苗的患者。从每年 9 月 1 日开始，我们使用滚动队列设计以 1:1 的比例对接种和未接种疫苗的患者进行匹配。使用 Kaplan-Meier 图比较死亡率和住院率，并在流感季节（季节内）使用风险比计算效果。2014-2015 年接种和未接种的队列分别包括 7503 名患者，2015-2016 年 10318 名，2016-2017 年 12723 名，2017-2018 年 13927 名。接种率在 2014-2015 年的季节内较低，为 43.2%，随着时间的推移逐渐下降，到 2017-2018 年的季节内降至 39.9%。2014-2015 年季节内全因死亡率的风险比为 0.79（95%置信区间 [CI]，0.65-0.97；=0.02），2015-2016 年为 0.66（95%CI，0.54-0.80；<0.001），2016-2017 年为 0.89（95%CI，0.76-1.04；=0.15），2017-2018 年为 0.95（95%CI，0.81-1.12；=0.57）。所有季节的全因住院率和与呼吸相关的住院率的影响相似。尽管不能证明流感疫苗接种对 ILD 患者有明确的益处，但我们在观察到的一半季节中观察到了避免全因死亡率的有希望的结果。鉴于低接种率，有必要进一步努力提高 ILD 患者的接种率。
