School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
Chin Med J (Engl). 2024 May 20;137(10):1179-1189. doi: 10.1097/CM9.0000000000002790. Epub 2023 Jul 24.
Influenza and pneumococcal vaccination are a priority in patients with chronic obstructive pulmonary disease (COPD). However, limited information is available on vaccination coverage among patients with acute exacerbations of COPD (AECOPD) in China. This study aimed to determine the rates and associated factors of influenza and pneumococcal vaccination in patients hospitalized with AECOPD.
Baseline data from a national, multicenter, hospital-based study that included adult inpatients with AECOPD between 2017 and 2021 were analyzed. The outcomes of interest were the influenza vaccination in the past year and the pneumococcal vaccination in the past 5 years. To ensure national representativeness, rates were weighted according to the distribution of hospital levels and types enrolled in this study. Multivariable Poisson regression based on mixed-effects models were used to determine the associated factors. The independent variables included the region and hospital features where the participants were located, sociodemographic characteristics (age, sex, rural/urban residence, education, etc.), and clinical indicators (COPD disease history, lung function parameters, comorbidities, etc.). The treatment profiles of the vaccinated and unvaccinated participants were compared.
Of 6949 eligible participants, the weighted rates of influenza/pneumococcal, influenza, and pneumococcal vaccination were 2.72% (95% confidence interval [CI]: 2.34%-3.10%), 2.09% (95% CI: 1.76%-2.43%), and 1.25% (95% CI: 0.99%-1.51%), respectively. In multivariable models, age ≥60 years (60-69 years, odds ratio [OR]: 1.90, 95% CI: 1.11-3.25; ≥80 years, OR: 2.00, 95% CI: 1.06-3.78), geographical regions (Northern China relative to Eastern China, OR: 5.09, 95% CI: 1.96-13.21), urban residence (OR: 1.69, 95% CI: 1.07-2.66), a higher education level (junior high school, OR: 1.77, 95% CI: 1.21-2.58; senior high school or above, OR: 2.61, 95% CI: 1.69-4.03), former smoking (OR: 1.79, 95% CI: 1.15-2.79), and regular inhaled medication treatment (OR: 3.28, 95% CI: 2.29-4.70) were positively associated with vaccination. Patients who had experienced severe exacerbations in the past year were less likely to be vaccinated (OR: 0.65, 95% CI: 0.45-0.96). Compared with unvaccinated participants, vaccinated participants adhered better to pharmacological and non-pharmacological treatment.
Influenza and pneumococcal vaccination coverage are extremely low. Urgent measures are necessary to increase vaccination coverage among inpatients with AECOPD in China.
流感和肺炎球菌疫苗接种是慢性阻塞性肺疾病（COPD）患者的优先事项。然而，在中国，关于 COPD 急性加重（AECOPD）患者疫苗接种覆盖率的信息有限。本研究旨在确定住院 AECOPD 患者中流感和肺炎球菌疫苗接种的比例及其相关因素。
对 2017 年至 2021 年期间全国多中心、基于医院的研究中成年 AECOPD 住院患者的基线数据进行分析。主要结局为过去一年的流感疫苗接种和过去 5 年的肺炎球菌疫苗接种。为确保全国代表性，根据本研究纳入的医院级别和类型的分布对比例进行加权。采用基于混合效应模型的多变量泊松回归确定相关因素。自变量包括参与者所在地区和医院的特征、社会人口学特征（年龄、性别、城乡居住、教育程度等）和临床指标（COPD 病史、肺功能参数、合并症等）。比较了接种和未接种参与者的治疗情况。
在 6949 名合格参与者中，流感/肺炎球菌、流感和肺炎球菌疫苗接种的加权比例分别为 2.72%（95%置信区间[CI]：2.34%-3.10%）、2.09%（95% CI：1.76%-2.43%）和 1.25%（95% CI：0.99%-1.51%）。在多变量模型中，年龄≥60 岁（60-69 岁，比值比[OR]：1.90，95%CI：1.11-3.25；≥80 岁，OR：2.00，95%CI：1.06-3.78）、地理位置（与东北地区相比，华北地区，OR：5.09，95%CI：1.96-13.21）、城市居住（OR：1.69，95%CI：1.07-2.66）、较高的教育水平（初中，OR：1.77，95%CI：1.21-2.58；高中或以上，OR：2.61，95%CI：1.69-4.03）、既往吸烟（OR：1.79，95%CI：1.15-2.79）和定期吸入药物治疗（OR：3.28，95%CI：2.29-4.70）与接种呈正相关。过去一年经历过严重加重的患者不太可能接种疫苗（OR：0.65，95%CI：0.45-0.96）。与未接种疫苗的参与者相比，接种疫苗的参与者更能坚持药物和非药物治疗。
流感和肺炎球菌疫苗接种率极低。在中国，迫切需要采取措施提高 AECOPD 住院患者的疫苗接种率。
