Prevalence and factors associated with influenza vaccination of persons over 65 years old in Spain (2009-2014)

Impact of Actively Offering Influenza Vaccination to Frail People during Hospitalisation: A Pilot Study in Italy

Despite the worldwide recommendations for influenza immunisation, vaccination coverage for patients exposed to the highest risk of severe complications is still far from the optimal target. The need to take advantage of alternative methods to provide vaccination is essential. This study presents a hospital-based strategy which offers influenza vaccination to inpatients at discharge. This study was conducted during the 2022-2023 influenza season at the University Hospital of Palermo. A questionnaire was administered to identify the determinants for the acceptance of influenza vaccination in the frail population. Overall, 248 hospitalised patients were enrolled, of which 56.1% were female and 52.0% were over 65 years of age. The proportion of patients vaccinated against influenza during hospitalisation was 62.5%, an increase of 16% in influenza vaccination uptake among frail people in comparison with the previous influenza season (46.8% vaccinated during the 2021-22 influenza season). Factors significantly associated with vaccination acceptance were the following: to have received influenza vaccine advice from hospital healthcare workers (OR = 3.57, p = 0.001), to have been previously vaccinated for influenza (OR = 3.16 p = 0.005), and to have had a low level of education (OR = 3.56, p = 0.014). This study showed that offering influenza vaccination to hospitalised patients could be an effective strategy to increase vaccination coverage in the most vulnerable population, and these findings could be useful for planning and improving future influenza vaccination campaigns.

A decade beyond the economic recession: A study of health-related lifestyles in urban and rural Spain (2006-2017)

The 2008 economic recession may have affected health-related indicators differently depending on the living environment. We analyze health-related indicators in Spain using data from four Spanish health surveys (2006, 2011, 2014, and 2017, 95 924 individuals aged ≥16 years). In 2006-2011, physical activity decreased among men and women, while in 2006-2017, physical activity only decreased among urban women. Daily vegetable intake, except in rural women, increased in 2006-2011 but decreased in 2006-2017 in all groups. Smoking decreased among urban women in 2006-2011 and 2006-2014 but only decreased among men, and even increased among rural women, in 2006-2017. In 2006-2017, obesity increased among men and urban women, good self-rated health status increased in all groups and flu vaccination declined. Blood pressure and cholesterol control decreased in urban women in 2006-2011 but increased in 2006-2017 in all groups, as well as mammographic and cytological control. Our findings highlight the differential impact of the economic recession on health-related lifestyles according to sex and place of residence, underscoring the need for targeted health policies to address evolving health disparities over time.

[Once vaccinated, always vaccinated? A claims data analysis on repeated influenza vaccinations among individuals aged ≥ 60 years]

BACKGROUND

The Standing Committee on Vaccination recommends the seasonal influenza vaccination as a standard vaccination for individuals aged ≥ 60 years and as an indication vaccination independent of age. Empirical data on repeated vaccination are not available for Germany. The aim of this study was therefore to investigate the frequency and influencing factors of repeated vaccinations.

METHODS

We conducted a longitudinal retrospective observational study with claims data from ≥ 60‑year-olds insured with the statutory health insurance AOK Plus in Thuringia between 2012 and 2018. The number of seasons with influenza vaccination was described and the association with various individual characteristics was analysed in a regression model.

RESULTS

Included were 103,163 individuals with at least one influenza vaccination in the 2014/2015 season, of whom 75.3% had been vaccinated in ≥ 6 of 7 seasons. We found repeated vaccinations more frequently among nursing home residents (rate ratio (RR) 1.27), individuals with increased health risk due to underlying diseases (RR 1.21) and higher age groups (vs. 60-69 years: RR 1.17-1.25). With each additional year of participating in a disease management program, the number of vaccinations increased (RR 1.03). Women (RR 0.91), individuals with nursing care level 1 (vs. no nursing care level: RR 0.90) and people with a comorbidity (vs. no comorbidity: RR 0.97) were less likely to receive repeated vaccinations.

DISCUSSION

A large proportion of individuals aged ≥ 60 years who have been vaccinated against influenza once is likely to repeatedly receive vaccinations. In accordance with vaccination recommendations, nursing home residents and in particular individuals with an increased health risk are vaccinated repeatedly. General practitioners play a central role: non-acute patient contacts should be used to offer vaccinations, especially to women and individuals in need of care who are living at home.

Influenza vaccination trend and related factors among patients with diabetes in Korea: Analysis using a nationwide database

BACKGROUND

Subjects with diabetes are at higher risk of serious influenza-related complications. We aimed to investigate the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza in subjects with diabetes using a nationwide observational study performed within the recent decade.

METHODS

Among 105,732 subjects from the Korea National Health and Nutrition Examination Survey between 2007 and 2019, 8,632 with diabetes were included. We investigated the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza.

RESULTS

During the study period, the prevalence of influenza vaccination in subjects with diabetes showed a tendency to increase every year, reaching almost 60% in 2019, which was higher than the rate in subjects without diabetes. Younger age (adjusted hazard ratio (aHR) [95% CI] 11.29 [8.63-14.75] for < 50 years; 6.16 [5.21-7.29] for 50-65 years), male (aHR 1.67 [1.52-1.87]), current smoker (aHR 1.31 [1.00-1.72], lower-income status (aHR 1.46 [1.17, 1.84]), and high education level (aHR 1.30 [1.01-1.67]) were associated with being unvaccinated. Also, a poorer glycemic control with HbA1c ≥ 9% was found to be correlated with unvaccinated status (aHR 1.48 [1.15-1.90]).

CONCLUSION

The influenza vaccination rate is still unsatisfactory in subjects with diabetes. Young age, males, low-income level, high education level, and poor glycemic control were associated with unvaccinated status. Considering the risk-benefits of influenza vaccination in patients with diabetes, physicians should make an effort to increase vaccination rates, especially in low vaccination rate groups.

Improving older adults' vaccination uptake: Are existing measures of vaccine hesitancy valid and reliable for older people?

We sought to establish whether two recently developed measures, the 5C scale and the Vaccination Attitudes Examination (VAX) were reliable and valid for use with older adults. A total of 372 UK-dwelling participants (65-92 years, M = 70.5 years, SD = 4.6) completed a cross-sectional survey measuring health and socio-demographic characteristics in relation to vaccine uptake for influenza, pneumococcal and shingles. The 5C and VAX scales were administered to test their reliability, validity and dimensionality. Both scales showed good internal reliability and convergent, discriminant and concurrent validity. Their factor structures were also confirmed, supporting their use with older adult populations.

Drivers of and barriers to routine adult vaccination: A systematic literature review

We performed a systematic literature review in PubMed and Embase (2016-2021) to investigate the drivers of and barriers to routine vaccination in adults aged 50 and older globally. A thematic assessment identified three categories across 61 publications: sociodemographic, health-related, and attitudinal. The most common sociodemographic determinants (factors identified in studies; n = 47) associated with vaccination uptake were economic status, age, education, and household composition, which had mixed effects on vaccine uptake. For health-related determinants (n = 27), individuals with comorbidities and health care consumption were the most common factors, both increased vaccine uptake. The most common attitudinal factors (n = 42) were self-efficacy, provider or other's recommendations, and vaccine-preventable disease awareness; across studies, all attitude factors had a positive effect, unlike the sociodemographic and health status categories. Findings suggest that patient and provider awareness and education campaigns are effective ways to increase uptake of routine vaccinations in older adults.

Time Trends (2012-2020), Sex Differences and Predictors for Influenza Vaccination Uptake among Individuals with Chronic Obstructive Pulmonary Disease in Spain

(1) Background: To analyze time trends, sex differences, and factors associated with influenza vaccination uptake among individuals with COPD in Spain, 2012−2020. (2) Methods: A cross-sectional study based on data from the European Health Surveys for Spain, 2020 (EHSS2020) and 2014 and from the Spanish National Health Interview Surveys for 2017 and 2012. (3) Results: The study included 65,447 participants. Prevalence of COPD was 5.9% (n = 3855). Overall, the influenza vaccination uptake among COPD patients was 57.8% versus 28.6% for those without COPD (p < 0.001). Men with COPD reported higher uptake than women in all the surveys studied. Neither the crude nor the multivariable analysis showed a significant variation change overtime for people with COPD. However, among those aged <65 years, crude uptake decreased from 2012 to 2020 (39.4% vs. 33.3%; p = 0.039). Over the entire period, men were vaccinated significantly more than women (OR 1.28; 95% CI 1.12−1.47). Among COPD participants, included in the EHSS2020, independent predictors of vaccine uptake included being male, higher age, reporting no current smoking and suffering cancer or heart disease. (4) Conclusions: In COPD patients, the influenza vaccination uptake is below desirable levels and did not improve from 2012 to 2020. Sex differences are found, with consistent and constant lower uptake among women with COPD. The observed lower uptake among COPD women and patients with unhealthy lifestyle requires increased attention.

Influenza vaccination uptake among high-risk target groups and health care workers in Spain and change from 2017 to 2020

OBJECTIVE

Using the 2020 European Health Survey for Spain (EHSS2020), which ran from July 2019 to July 2020, we aimed to describe influenza vaccination uptake among the following target groups; individuals aged ≥65 years, health care workers (HCWs), and persons with high-risk chronic medical conditions. We analyzed changes in uptake since the previous Spanish National Health Interview Survey conducted in 2017 and identified variables associated with vaccine uptake.

METHODS

We performed a cross-sectional study. The primary study variable was the self-reported uptake of influenza vaccine in the previous year. We analyzed sex, age, country of birth, and being an HCW. We identified participants with self-reported respiratory diseases, cardiovascular disease, diabetes, cancer, and cerebrovascular diseases. Multivariable logistic regression was applied to assess changes over time and to identify variables associated with vaccination in target groups.

RESULTS

Uptake was 19.2% in 22,072 participants aged ≥15 years. Uptake was 54.4% for those aged ≥65 years, 41.6% for those with a high-risk medical condition, and 26.53% among HCWs. Uptake by disease was 52.1% for cerebrovascular diseases, 51.3% for cardiovascular diseases, 48.3% for diabetes, 46.1% for cancer, and 36.2% for respiratory diseases. No significant improvement has been observed since 2017 in any target group, except for participants with cancer, whose uptake increased from 33.2% to 46.1%(p < 0.001). The variables that significantly increased the probability of reporting vaccine uptake were female sex, age ≥35 years, being born in Spain, self-reported respiratory or cardiovascular diseases, diabetes, cancer, and being a HCW.

CONCLUSIONS

Influenza vaccination uptake among target groups in Spain is below desirable levels and has not improved significantly since 2017. Older age, female sex, and being born in Spain are positive predictors of vaccine uptake. The COVID-19 pandemic highlights the urgent need to implement new strategies to increase influenza vaccine uptake.

Older adults' vaccine hesitancy: Psychosocial factors associated with influenza, pneumococcal, and shingles vaccine uptake

Influenza, pneumococcal disease, and shingles (herpes zoster) are more prevalent in older people. These illnesses are preventable via vaccination, but uptake is low and decreasing. Little research has focused on understanding the psychosocial reasons behind older adults' hesitancy towards different vaccines. A cross-sectional survey with 372 UK-based adults aged 65-92 years (M = 70.5) assessed awareness and uptake of the influenza, pneumococcal, and shingles vaccines. Participants provided health and socio-demographic data and completed two scales measuring the psychosocial factors associated with vaccination behaviour. Self-reported daily functioning, cognitive difficulties, and social support were also assessed. Participants were additionally given the opportunity to provide free text responses outlining up to three main reasons for their vaccination decisions. We found that considerably more participants had received the influenza vaccine in the last 12 months (83.6%), relative to having ever received the pneumococcal (60.2%) and shingles vaccines (58.9%). Participants were more aware of their eligibility for the influenza vaccine, and were more likely to have been offered it. Multivariate logistic regression analyses showed that a lower sense of collective responsibility independently predicted lack of uptake of all three vaccines. Greater calculation of disease and vaccination risk, and preference for natural immunity, also predicted not getting the influenza vaccine. For both the pneumococcal and shingles vaccines, concerns about profiteering further predicted lack of uptake. Analysis of the qualitative responses highlighted that participants vaccinated to protect their own health and that of others. Our findings suggest that interventions targeted towards older adults would benefit from being vaccine-specific and that they should emphasise disease risks and vaccine benefits for the individual, as well as the benefits of vaccination for the wider community. These findings can help inform intervention development aimed at increasing vaccination uptake in future.

Inequalities in the long-term impact of the economic recession on preventive healthcare use and health-related lifestyle in Spain (2006-2017)

Study of the long-term impact of economic recession on lifestyle according to socioeconomic groups is scarce. This study examines health-related lifestyle and preventive medical attendance in different socioeconomic groups in the Spanish adult population (18-64 years of age) before, during and after an economic recession. Data were collected from three waves of the Spanish National Health Survey (2006, 2012 and 2017). Self-perceived health, health-related lifestyle and common preventive medical attendance were evaluated by means of multivariate logistic models. The increase in good self-perceived health in 2006-2012 was 7.1%, 6.9% and 8.3% for the high, middle and low group, respectively, and 5.2%, 5.9% and 7.9% for the high, middle and low group, respectively, in 2006-2017. In 2006-2012 and 2006-2017, the gap increased between people of the high and low groups in smoking prevalence (2.8%-4.7%), physical activity (2.0%-4.0%), daily fruit (1.0%-6.3%) and vegetable intake (2.5%-6.1%). The probability of women´s gynaecological attendance increased statistically significant for cytology in three groups in 2006-2012 and 2006-2017 (OR = 1.35, 95% CI = 1.08-1.67; OR = 1.42, 95% CI = 1.18-1.7; OR = 1.34, 95% CI = 1.21-1.47 for the high, middle and low groups, respectively, in 2006-2012 and OR = 1.34, 95% CI = 1.08-1.67; OR = 1.62, 95% CI = 1.35-1.95; OR = 1.51, 95% CI = 1.37-1.66 for the high, middle and low groups, respectively, in 2006-2017), but not for mammography. This study reveals long-term socioeconomic inequalities in lifestyle behaviours after the economic recession. Health policies must be emphasised in these population subgroups and in more disadvantaged populations.

Trends, Coverage and Influencing Determinants of Influenza Vaccination in the Elderly: A Population-Based National Survey in Spain (2006-2017)

Influenza is a significant public health problem and the elderly are at a greater risk of contracting the disease. The vaccination coverage of the elderly is below the Spanish target of 65% for each influenza season. The aims of this study were to report the coverage of influenza vaccination in Spain among the population aged ≥65 years and high-risk groups for suffering chronic diseases, to analyze the time trends from 2006 to 2017 and to identify the factors which affect vaccination coverage. A nationwide cross-sectional study was conducted including 20,753 non-institutionalized individuals aged ≥65 years who had participated in the Spanish National Health Surveys in 2006, 2011/2012, and 2017. Sociodemographic, health-related variables, and influenza vaccination data were used. A logistic regression analysis was performed to determine the variables associated with influenza vaccination. Influenza vaccination coverage was 60%. By chronic condition, older people with high cholesterol levels and cancer had the lowest vaccination coverage (62.41% and 60.73%, respectively). This coverage declined from 2006 to 2017 in both groups. Higher influenza vaccination was associated with males, Spanish nationality, normal social support perceived, polypharmacy, worse perceived health, participation in other preventive measures, and increasing age and the number of chronic diseases.

Seasonal influenza vaccination in older people: A systematic review and meta-analysis of the determining factors

Background/Objectives

Despite influenza vaccination programs in various jurisdictions, seasonal influenza vaccine (SIV) uptake remains suboptimal among older people (≥65years old), an important subpopulation for influenza vaccination. We sought to summarize determinants of SIV uptake (any vaccine receipt) and vaccination adherence (receipt of vaccine in two or more seasons in sequence) among older people.

Methods

We searched for population-based studies conducted in community-dwelling older people (irrespective of their health status) from 2000–2019. Two reviewers independently selected publications for inclusion. One reviewer extracted data from the included studies; a second checked the extracted data for errors. Disagreements were resolved by discussion and consensus, or a third reviewer. We were interested in the determinants of SIV uptake and vaccination adherence. Where appropriate, we pooled adjusted results using the inverse variance, random-effects method and reported the odds ratios (OR) and their 95% confidence intervals (CI).

Results

Out of 11,570 citations screened, we included 34 cross-sectional studies. The following were associated with increased SIV uptake: being older (OR 1.52, 95%CI 1.38–1.67 [21 studies]), white (1.30, 1.14–1.49 [10 studies]), married (1.23, 1.17–1.28 [9 studies]), non-smoker (1.28, 1.11–1.47 [7 studies]), of a higher social class (1.20, 1.06–1.36 [2 studies]), having a higher education (1.12, 1.04–1.21 [14 studies]), having a higher household income (1.11, 1.05–1.18 [8 studies]), having a chronic illness (1.53, 1.44–1.63 [16 studies]), having poor self-assessed health (1.23, 1.02–1.40 [9 studies]), having a family doctor (2.94, 1.79–4.76 [2 studies]), and having health insurance (1.58, 1.13–2.21 [6 studies]). The influence of these factors varied across geographical regions. Being older (1.26, 1.11–1.44 [2 studies]) was also associated with increased vaccination adherence.

Conclusions

Several factors may determine SIV uptake and vaccination adherence among older people. More studies are needed to provide a stronger evidence base for planning more effective influenza vaccination programs.

Decreasing influenza vaccine coverage among adults with high-risk chronic diseases in Spain from 2014 to 2017

The objectives of this study were to estimate coverage of influenza vaccination in Spain among adults suffering chronic conditions, to assess time trends from 2014 to 2017 and to identify vaccine uptake predictors. We used individualized data of persons ≥15 y interviewed in the 2017 Spanish National Health Survey. Vaccine uptake and the presence of the chronic conditions analyzed (diabetes; cancer; chronic respiratory disease; chronic heart disease and cerebrovascular disease) were self-reported. Independent variables included sex, age and nationality. In 2017 overall influenza vaccination uptake among subjects with high-risk chronic conditions remained low (40.3%) and decreased significantly from 2014 (41.7%, adjusted OR 0.98 95%CI 0.84-0.98). The highest coverage was found among those with cerebrovascular disease (52.2%), diabetes (51.5%) and heart disease (51.4%) and the lowest figures for those suffering cancer (34.9%) and respiratory disease (35.1%). Coverage for cancer patients declined a 25% from 2014 to 2017. Older persons had higher coverages whereas females and immigrant population had lower uptakes.We conclude that influenza vaccination coverage among the high-risk population in Spain for suffering chronic conditions remains at a low level and has decreased significantly from 2014 to 2017, this affects more intensely to females and immigrants.

[Analysis of the refusal of the flu vaccination (REGRIVI study)]

INTRODUCTION

The objective of this study is to determine the reasons for refusing the flu vaccination in the Primary Care Health Centre of Vilanova de Arousa, Spain, as well as to evaluate the flu vaccination coverage after an educational intervention.

MATERIAL AND METHODS

A quasi-experimental before and after study was conducted after an educational intervention on a total of 73 people that included those Primary Care Health Centre patients from Vilanova de Arousa who had refused the flu vaccination in 2014, and who did not meet the exclusion criteria (death during 2014 and 2015 campaigns, non-acceptance of participation, vaccine registration mistakes, contraindication or no indication for the vaccine, inability to contact). After a brief educational intervention, vaccination data from those patients in the 2015 and 2016 campaigns were checked. A descriptive analysis of the variables under study was then carried out. Of the 73 patients initially included, 72 completed the study.

RESULTS

The main reasons for refusing a vaccination were the concerns about the adverse effects and patient perception of good health. Vaccination coverage was 50.7% in 2015, and 48.6% in 2016.

CONCLUSIONS

The reasons for refusing vaccination are approachable with a brief intervention since the refusal decreases by half in the long-term.