Rezaei Satar, Karami Matin Behzad, Najafi Farid, Ahmadi Sina, Heidarzadeh Arani Amahtis, Brown Heather
Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Research Center for Environmental Determinants of Health, Health Institute, across from Farabi Hospital, Kermanshah University of Medical Sciences, Isar Sq, Kermanshah, 6719851351, Iran.
BMC Geriatr. 2025 Jul 2;25(1):473. doi: 10.1186/s12877-025-06144-9.
There is limited evidence regarding socioeconomic-related inequalities in flu vaccination uptake among the elderly in developing countries like Iran. This study aims to examine these inequalities and identify the main determinants of observed inequalities among the elderly in Iran.
In this cross-sectional study, we collected data on sociodemographic factors, economic status, flu vaccination history, and reasons for receiving or declining the vaccine among 1,192 individuals aged 60 years and older through multistage sampling in 2024. Monthly household expenditures were used as a proxy to measure the economic status of the participants' households. We initially employed multiple logistic regression to assess the main factors affecting flu vaccination uptake among the samples. Subsequently, we utilized the concentration curve (CC) and concentration index (CI), specifically Wagstaff normalized CI and Erreygers normalized CI, to illustrate and quantify socioeconomic inequalities in flu vaccination uptake. Additionally, decomposition analysis was conducted to identify primary determinants of economic-related inequality in flu vaccination.
This study found that the prevalence of flu vaccination uptake among the elderly was 29.69% (n = 354) for the current or previous flu season and 40.81% (n = 486) for having ever received a flu vaccination at any time in their lives. Key factors influencing vaccination included education level, monthly household expenditures, consultations with health professionals, trust in healthcare providers, and prior vaccination history. Both Wagstaff normalized CI and Erreygers normalized CI indicated that vaccination distribution was disproportionately concentrated among wealthier groups. Decomposition analysis revealed that flu vaccination history (101.1%), household costs (21.3%), consultations regarding flu vaccination from health centers or professionals (13.6%), trust in health professionals concerning flu vaccination (12.4%), and education level (7.9%). were significant determinants of observed inequalities.
This study highlights significant socioeconomic inequalities in flu vaccination uptake among the elderly in Iran, indicating that wealthier individuals are more likely to receive vaccinations. Addressing these disparities through targeted interventions is essential for improving vaccination rates and overall public health outcomes among vulnerable populations.
在伊朗等发展中国家，关于老年人流感疫苗接种率中与社会经济相关的不平等现象，证据有限。本研究旨在调查这些不平等现象，并确定伊朗老年人中观察到的不平等现象的主要决定因素。
在这项横断面研究中，我们于2024年通过多阶段抽样，收集了1192名60岁及以上个体的社会人口学因素、经济状况、流感疫苗接种史以及接种或拒绝接种疫苗的原因等数据。用家庭月支出作为衡量参与者家庭经济状况的指标。我们首先采用多元逻辑回归来评估影响样本中流感疫苗接种率的主要因素。随后，我们利用浓度曲线（CC）和浓度指数（CI），特别是瓦格斯塔夫标准化CI和埃雷格斯标准化CI，来说明和量化流感疫苗接种率中的社会经济不平等现象。此外，还进行了分解分析，以确定流感疫苗接种中与经济相关不平等的主要决定因素。
本研究发现，在当前或上一个流感季节，老年人流感疫苗接种率为29.69%（n = 354），一生中曾接种过流感疫苗的比例为40.81%（n = 486）。影响疫苗接种的关键因素包括教育水平、家庭月支出、与卫生专业人员的咨询、对医疗服务提供者的信任以及既往疫苗接种史。瓦格斯塔夫标准化CI和埃雷格斯标准化CI均表明，疫苗接种分布不成比例地集中在较富裕群体中。分解分析显示，流感疫苗接种史（101.1%）、家庭成本（21.3%）、来自卫生中心或专业人员的流感疫苗接种咨询（13.6%）、对卫生专业人员关于流感疫苗接种的信任（12.4%）以及教育水平（7.9%）是观察到的不平等现象的重要决定因素。
本研究突出了伊朗老年人在流感疫苗接种率方面存在显著的社会经济不平等现象，表明较富裕的个体更有可能接种疫苗。通过有针对性的干预措施解决这些差异，对于提高弱势群体的疫苗接种率和总体公共卫生结果至关重要。
