Abstract
BackgroundAnnual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but their SIV rates remain far below public health targets. We aimed to identify temporal trajectories of SIV uptake over a 10-year period among French people with diabetes and describe their clinical characteristics.MethodsWe identified patients with diabetes in 2006 among a permanent, representative sample of beneficiaries of the French National Health Insurance Fund. We followed them up over 10 seasons (2005/06–2015/16), using SIV reimbursement claims and group-based trajectory modelling to identify SIV trajectories and to study sociodemographic, clinical, and healthcare utilization characteristics associated with the trajectories.ResultsWe identified six trajectories. Of the 15,766 patients included in the model, 4344 (28%) belonged to the “continuously vaccinated” trajectory and 4728 (30%) to the “never vaccinated” one. Two other trajectories showed a “progressive decrease” (2832, 18%) or sharp “postpandemic decrease” (1627, 10%) in uptake. The last two trajectories (totalling 2235 patients, 14%) showed an early or delayed “increase” in uptake. Compared to “continuously vaccinated” patients, those in the “progressively decreasing” trajectory were older and those in all other trajectories were younger with fewer comorbidities at inclusion. Worsening diabetes and comorbidities during follow-up were associated with the “increasing” trajectories.ConclusionsMost patients with diabetes had been continuously vaccinated or never vaccinated and thus had stable SIV behaviours. Others adopted or abandoned SIV. These behaviour shifts might be due to increasing age, health events, or contextual factors (e.g., controversies about vaccine safety or efficacy). Healthcare professionals and stakeholders should develop tailored strategies that take each group’s specificities into account.
Highlights
Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but their SIV rates remain far below public health targets
Gender, district of residence, reimbursement claims for consultations with private healthcare professionals, medical procedures, drugs purchased in the community (classified by Anatomical Therapeutic Chemical (ATC) codes), and long-term illness (LTI) status, recorded by expert physicians according to the International Classification of Diseases (ICD-10)
About 10% were identified with type 1 diabetes at inclusion; only 70% had LTI status for diabetes
Summary
Annual seasonal influenza vaccination (SIV) is recommended for people with diabetes, but their SIV rates remain far below public health targets. We aimed to identify temporal trajectories of SIV uptake over a 10-year period among French people with diabetes and describe their clinical characteristics. The SIV rate in this population is SIV must be repeated annually, few cohort studies have explored the course of SIV behaviours for several consecutive years They have found evidence for both stable SIV behaviours and behaviour shifts (e.g., stopping SIV) [9, 10], suggesting that distinct temporal patterns (trajectories) of SIV behaviour may exist. This article sought to: 1) identify temporal patterns (trajectories) of SIV uptake among French people with diabetes over 10 consecutive influenza seasons (2005/06 to 2015/16) and determine their prevalence; and 2) study the sociodemographic, clinical, and healthcare utilization characteristics associated with them
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