Abstract
The aim of this study was to estimate the prevalence of non-vaccination against influenza among Brazilian older adults with systemic arterial hypertension and determine the main reasons for non-adherence. A cross-sectional study was conducted using data from older adults (≥ 60 years of age) with hypertension who participated in the 2013 National Health Survey and reported not having been vaccinated against flu over the previous 12 months (n = 1,295). The analyses were performed using the Stata 14.0 software. The data were weighted because of the sampling design. An estimated 3,026,080 older adults with hypertension had not received a flu vaccine over the 12 months prior to the survey (22.6%). No significant associations were found with sex, age group or schooling. The prevalence of unvaccinated older adults was lower in the southern and southeastern regions of Brazil than in the northern and northeastern regions, even after adjusting for age. The prevalence was higher among individuals without private health insurance. The main reasons for non-vaccination were fear of a reaction, rarely having the flu and not believing in the protection of the vaccine. The present findings underscore the need for healthcare professionals to explain to the population the benefits of the vaccine for preventing severe influenza (protective effect and possible reactions) and for secondary prevention of cardiovascular events. Increasing the prevalence of vaccination in older adults with hypertension and other cardiovascular diseases is of fundamental importance within the realm of public health as a strategy for reducing occurrences of complications and deaths associated with influenza.
Highlights
Data from the Brazilian National Health Survey revealed rates of 44.4%, 52.7% and 55.0% among Brazilian elderly people aged 60-64, 65-74 and ≥ 75 years, respectively,[4] and the prevalence increased with age (71.7% of individuals aged ≥ 70 years had high blood pressure or reported taking antihypertensive medication).[3]
It was estimated that 3,026,080 elderly people with hypertension had not been vaccinated against influenza (22.6%; 95% CI: 20.9-24.5)
In northeastern Brazil, the peaks of the disease occur prior to the period when vaccination campaigns have been run,[20] and this may have had an impact on the effectiveness of such campaigns as well as on the perceptions of elderly people regarding the protection offered by the vaccine, which will have had a negative influence on adherence
Summary
Systemic arterial hypertension is a major risk factor for other cardiovascular diseases[1] and is highly prevalent in both adults and elderly people.[2,3] Data from the Brazilian National Health Survey revealed rates of 44.4%, 52.7% and 55.0% among Brazilian elderly people aged 60-64, 65-74 and ≥ 75 years, respectively,[4] and the prevalence increased with age (71.7% of individuals aged ≥ 70 years had high blood pressure or reported taking antihypertensive medication).[3]Individuals with cardiovascular disease are at greater risk of complications from influenza.[5,6] Besides the risk factors described in the literature (hypertension, obesity, physical inactivity, smoking, etc.), influenza contributes to cardiovascular morbidity and mortality.[6]. The United Kingdom National Clinical Guideline Centre[8] and the Brazilian Cardiology Society[9] indicate the vaccine for individuals with heart failure
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