Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, D.C., United States.
Department of Pharmaceutical and Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, United States.
Vaccine. 2022 Apr 26;40(19):2696-2704. doi: 10.1016/j.vaccine.2022.03.058. Epub 2022 Mar 29.
Little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected influenza vaccine utilization and disparities. We sought to estimate changes in the likelihood of receiving an influenza vaccine across different demographic subgroups during the COVID-19 pandemic.
In this cohort study, we analyzed influenza vaccine uptake from 2019 to 2020 using Optum commercial insurance claims data. Eligible individuals were aged 18 or above in 2018 and continuously enrolled from 08/01/2018 through 12/31/2020. Multivariable logistic regressions were fitted for the individual-level influenza vaccine uptake. Adjusting for demographic factors and medical histories, we estimated probabilities of receiving influenza vaccines before and after the COVID-19 pandemic across demographic subgroups.
From August to December 2019, unadjusted influenza vaccination rate was 42.3%, while in the same period of 2020, the vaccination rate increased to 45.9%. Females had a higher vaccination rate in 2019 (OR: 1.16, 95% CI 1.15-1.16), but the increase was larger for males. Blacks and Hispanics had lower vaccination rates relative to whites in both flu seasons. Hispanics showed a greater increase in vaccination rate, increasing by 7.8 percentage points (p < .001) compared to 4.4 (p < .001) for whites. The vaccination rate for Blacks increased by 5.2 percentage points (p < .001). All income groups experienced vaccination improvements, but poorer individuals had lower vaccination rates in both seasons. The most profound disparities occurred when educational cohort were considered. The vaccination rate increased among college-educated enrollees by 8.8 percentage points (p < .001) during the pandemic compared to an increase of 2.8 percentage points (p < .001) for enrollees with less than a 12th grade education. Past influenza infections or vaccination increased the likelihood of vaccination (p < .001).
The COVID-19 pandemic was associated with increased influenza vaccine utilization. Disparities persisted but narrowed with respect to gender and race but worsened with respect to income and educational attainment.
关于 2019 年冠状病毒病（COVID-19）大流行如何影响流感疫苗的使用和差异知之甚少。我们试图估计 COVID-19 大流行期间不同人群亚组中接受流感疫苗的可能性的变化。
在这项队列研究中，我们使用 Optum 商业保险理赔数据分析了 2019 年至 2020 年的流感疫苗接种情况。符合条件的个体在 2018 年年龄为 18 岁或以上，并且在 2018 年 8 月 1 日至 2020 年 12 月 31 日期间连续入组。对个体水平的流感疫苗接种情况进行多变量逻辑回归分析。在调整人口统计学因素和病史的基础上，我们估计了在不同人群亚组中 COVID-19 大流行前后接受流感疫苗的概率。
2019 年 8 月至 12 月，未经调整的流感疫苗接种率为 42.3%，而 2020 年同期接种率上升至 45.9%。女性在 2019 年的接种率更高（OR：1.16，95%CI 1.15-1.16），但男性的增幅更大。黑人和西班牙裔相对于白人在两个流感季节的接种率都较低。与白人相比，西班牙裔的疫苗接种率增加了 7.8 个百分点（p<0.001），而白人增加了 4.4 个百分点（p<0.001）。黑人的疫苗接种率增加了 5.2 个百分点（p<0.001）。所有收入群体的疫苗接种率都有所提高，但在两个季节中，收入较低的人群的疫苗接种率较低。当考虑教育队列时，最显著的差异就出现了。在大流行期间，接受过大学教育的接种者的疫苗接种率增加了 8.8 个百分点（p<0.001），而受教育程度低于 12 年级的接种者的疫苗接种率增加了 2.8 个百分点（p<0.001）。过去的流感感染或接种增加了接种的可能性（p<0.001）。
COVID-19 大流行与流感疫苗使用率的增加有关。性别和种族方面的差异有所缩小，但收入和教育程度方面的差异有所扩大。
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