Nichol K L, Margolis K L, Wuorenma J, Von Sternberg T
Section of General Internal Medicine, Veterans Affairs Medical Center, Minneapolis, MN 55417.
N Engl J Med. 1994 Sep 22;331(12):778-84. doi: 10.1056/NEJM199409223311206.
Despite recommendations for annual vaccination against influenza, more than half of elderly Americans do not receive this vaccine. In a serial cohort study, we assessed the efficacy and cost effectiveness of influenza vaccine administered to older persons living in the community.
Using administrative data bases, we studied men and women over 64 years of age who were enrolled in a large health maintenance organization in the Minneapolis-St. Paul area. We examined the rate of vaccination and the occurrence of influenza and its complications in each of three seasons: 1990-1991, 1991-1992, and 1992-1993. Outcomes were adjusted for age, sex, diagnoses indicating a high risk, use of medications, and previous use of health care services.
Each cohort included more than 25,000 persons 65 years of age or older. Immunization rates ranged from 45 percent to 58 percent. Although the vaccine recipients had more coexisting illnesses at base line than those who did not receive the vaccine, during each influenza season vaccination was associated with a reduction in the rate of hospitalization for pneumonia and influenza (by 48 to 57 percent, P < or = 0.002) and for all acute and chronic respiratory conditions (by 27 to 39 percent, P < or = 0.01). Vaccination was also associated with a 37 percent reduction (P = 0.04) in the rate of hospitalization for congestive heart failure during the 1991-1992 season, when influenza A was epidemic. The costs of hospitalization for all types of illness studied were lower in the vaccinated group during 1991-1992 (range of reduction, 47 to 66 percent; P < 0.005) and for acute and chronic respiratory conditions and congestive heart failure in 1990-1991 (reductions of 37 percent and 43 percent, respectively; P < or = 0.05). Direct savings per year averaged $117 per person vaccinated (range, $21 to $235), with cumulative savings of nearly $5 million. Vaccination was also associated with reductions of 39 to 54 percent in mortality from all causes during the three influenza seasons (P < 0.001).
For elderly citizens living in the community, vaccination against influenza is associated with reductions in the rate of hospitalization and in deaths from influenza and its complications, as compared with the rates in unvaccinated elderly persons, and vaccination produces direct dollar savings.
尽管建议每年接种流感疫苗，但超过半数的美国老年人未接种该疫苗。在一项系列队列研究中，我们评估了给社区老年居民接种流感疫苗的有效性和成本效益。
利用管理数据库，我们研究了明尼阿波利斯 - 圣保罗地区一家大型健康维护组织中64岁以上的男性和女性。我们考察了1990 - 1991年、1991 - 1992年和1992 - 1993年这三个季节中每个季节的疫苗接种率以及流感及其并发症的发生情况。对年龄、性别、表明高风险的诊断、药物使用情况以及先前的医疗服务使用情况进行了结果调整。
每个队列都包含超过25000名65岁及以上的人。免疫接种率在45%至58%之间。尽管疫苗接种者在基线时比未接种疫苗者患有更多的并存疾病，但在每个流感季节，接种疫苗与肺炎和流感住院率的降低相关（降低48%至57%，P≤0.002）以及所有急慢性呼吸道疾病住院率的降低相关（降低27%至39%，P≤0.01）。在1991 - 1992年甲型流感流行季节，接种疫苗还与充血性心力衰竭住院率降低37%相关（P = 0.04）。在1991 - 1992年，接种疫苗组所有研究类型疾病的住院费用较低（降低幅度为47%至66%；P < 0.005），在1990 - 1991年，急慢性呼吸道疾病和充血性心力衰竭的住院费用也较低（分别降低37%和43%；P≤0.05）。每年每位接种疫苗者平均直接节省117美元（范围为21美元至235美元），累计节省近500万美元。在三个流感季节中，接种疫苗还与各种原因导致的死亡率降低39%至54%相关（P < 0.001）。
对于社区老年居民，与未接种疫苗的老年人相比，接种流感疫苗与住院率降低以及流感及其并发症导致的死亡人数减少相关，并且接种疫苗可直接节省费用。
