Abstract
ObjectiveTo quantify inequalities in zoster vaccine uptake by determining its association with socio-demographic factors: age, gender, ethnicity, immigration status, deprivation (at Lower-layer Super Output Area-level), care home residence and living arrangements.MethodThis population-based cohort study utilised anonymised primary care electronic health records from England (Clinical Practice Research Datalink) linked to deprivation and hospitalisation data. Data from 35,333 individuals from 277 general practices in England and eligible for zoster vaccination during the two-year period (2013–2015) after vaccine introduction were analysed. Logistic regression was used to obtain adjusted odds ratios (aOR) for the association of socio-demographic factors with zoster vaccine uptake for adults aged 70 years (main target group) and adults aged 79 years (catch-up group).ResultsAmongst those eligible for vaccination, 52.4% (n = 18,499) received the vaccine. Socio-demographic factors independently associated with lower zoster vaccine uptake in multivariable analyses were: being older (catch-up group: aged 79 years) aOR = 0.89 (95% confidence interval (CI):0.85–0.93), care home residence (aOR = 0.64 (95%CI: 0.57–0.73)) and living alone (aOR = 0.85 (95%CI: 0.81–0.90)). Uptake decreased with increasing levels of deprivation (p-value for trend<0.0001; aOR most deprived versus least deprived areas = 0.69 (95%CI: 0.64–0.75)). Uptake was also lower amongst those of non-White ethnicities (for example, Black versus White ethnicity: aOR = 0.61 (95%CI: 0.49–0.75)) but was not lower among immigrants after adjusting for ethnicity. Lower uptake was also seen amongst females compared to men in the catch-up group.ConclusionsInequalities in zoster vaccine uptake exist in England; with lower uptake among those of non-White ethnicities, and among those living alone, in a care home and in more deprived areas. Tailored interventions to increase uptake in these social groups should assist in realising the aim of mitigating vaccination inequalities. As care home residents are also at higher risk of zoster, improving the uptake of zoster vaccination in this group will also mitigate inequalities in zoster burden.
Highlights
Zoster is caused by reactivation of latent varicella-zoster virus infection and mainly affects older individuals
Inequalities in zoster vaccine uptake exist in England; with lower uptake among those of non-White ethnicities, and among those living alone, in a care home and in more deprived areas
It is characterised by a painful dermatomal rash which may be followed by persisting pain called post-herpetic neuralgia (PHN).[1]
Summary
Zoster is caused by reactivation of latent varicella-zoster virus infection and mainly affects older individuals It is characterised by a painful dermatomal rash which may be followed by persisting pain called post-herpetic neuralgia (PHN).[1] Amongst individuals aged 70 years in England and Wales, an estimated ~53,000 cases of zoster occur annually of which ~27% develop post-herpetic neuralgia.[2] To reduce zoster disease burden, the UK introduced a national zoster vaccination programme (using a live vaccine: Zostavax manufactured by Merck and Co. Inc., USA) in 2013, targeting individuals aged 70 years, with a catch-up programme targeting older age groups.[3,4,5] The programme comprises vaccine administration to individuals aged 70 years on 1 September of the corresponding year (the routine cohort). Uptake of the programme was around ~62% in the routine cohort but has decreased to ~55% in 2015–2016. [8] The reasons cited for this decline include difficulties experienced by general practice personnel who were busy with seasonal influenza vaccination, challenges in identifying individuals eligible for vaccination, insufficient follow-up of unvaccinated individuals and a potential decline in vaccine knowledge amongst the eligible cohort.[6,7,8]
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