Abstract
Older adults with chronic conditions are at high risk of complications from influenza and pneumococcal infections. Evidence about factors associated with influenza and pneumococcal vaccination among older multimorbid persons in Europe is limited. The aim of this study was to investigate the prevalence and determinants of these vaccinations in this population. Multimorbid patients aged ≥70 years with polypharmacy were enrolled in 4 European centers in Switzerland, Belgium, the Netherlands, and Ireland. Data on vaccinations, demographics, health care contacts, and comorbidities were obtained from self-report, general practitioners and medical records. The association of comorbidities or medical contacts with vaccination status was assessed using multivariable adjusted log-binomial regression models. Among 1956 participants with available influenza vaccination data (median age 79 years, 45% women), 1314 (67%) received an influenza vaccination within the last year. Of 1400 patients with available pneumococcal vaccination data (median age 79 years, 46% women), prevalence of pneumococcal vaccination was 21% (n = 291). The prevalence of vaccination remained low in high-risk populations with chronic respiratory disease (34%) or diabetes (24%), but increased with an increasing number of outpatient medical contacts. Chronic respiratory disease was independently associated with the receipt of both influenza and pneumococcal vaccinations (prevalence ratio [PR] 1.09, 95% confidence interval [CI] 1.03-1.16; and PR 2.03, 95%CI 1.22-3.40, respectively), as was diabetes (PR 1.06, 95%CI 1.03-1.08; PR 1.24, 95%CI 1.16-1.34, respectively). An independent association was found between number of general practitioner visits and higher prevalence of pneumococcal vaccination (p for linear trend <0.001). Uptake of influenza and particularly of pneumococcal vaccination in this population of European multimorbid older inpatients remains insufficient and is determined by comorbidities and number and type of health care contacts, especially outpatient medical visits. Hospitalization may be an opportunity to promote vaccination, particularly targeting patients with few outpatient physician contacts.
Highlights
Seasonal influenza is a contagious viral respiratory disease, which can cause mild to severe illness
Prevalence of influenza and pneumococcal vaccination and its determinants in multimorbid older inpatients request for researchers whose proposed use of the data has been approved by the OPERAM publication committee
We used log-binomial regression models because this is the recommended method to estimate prevalence ratios [37, 38]. We adjusted these models for age, sex, race, education, alcohol use, and smoking status to investigate whether or not health conditions and medical resource utilization were associated with vaccination status independent of these variables
Summary
Seasonal influenza is a contagious viral respiratory disease, which can cause mild to severe illness. Influenza affects approximately 4 to 50 million individuals and causes 15,000 to 70,000 deaths in the European Union (EU) each year [1]. Older persons and those with chronic medical conditions are most vulnerable of developing associated complications, which can lead to hospitalization and death [2, 3]. Health authorities from almost all EU countries recommend the influenza vaccination for individuals over 65 years of age independently of their comorbidities [4]. Most but not all European countries recommend pneumococcal vaccination for all individuals over 65 years of age independently of their comorbidities [14]. The aim of this study was to investigate the prevalence and determinants of these vaccinations in this population
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