Patient and practice level factors associated with seasonal influenza vaccine uptake among at-risk adults in England, 2011 to 2016: An age-stratified retrospective cohort study
Matthew M. Loiacono,
Salaheddin M. Mahmud,
Ayman Chit,
Robertus van Aalst,
Jeffrey C. Kwong,
Nicholas Mitsakakis,
Luke Skinner,
Edward Thommes,
Hélène Bricout,
Paul Grootendorst
Affiliations
Matthew M. Loiacono
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada; Corresponding author at: Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Room 601, Toronto, ON M5S 3M2, Canada.
Salaheddin M. Mahmud
College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada; Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada
Ayman Chit
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada; Vaccine Epidemiology and Modeling, Sanofi Pasteur, 1 Discovery Dr, Swiftwater, PA 18370, United States
Robertus van Aalst
Vaccine Epidemiology and Modeling, Sanofi Pasteur, 1 Discovery Dr, Swiftwater, PA 18370, United States; Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9700 AB Groningen, the Netherlands
Jeffrey C. Kwong
ICES, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada; Public Health Ontario, 480 University Ave #300, Toronto, ON M5G 1V2, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Department of Family & Community Medicine, University of Toronto, 500 University Ave, Toronto, ON M5G 1V7, Canada; University Health Network, 101 College St, Toronto, ON M5G 1L7, Canada
Nicholas Mitsakakis
Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; University Health Network, 101 College St, Toronto, ON M5G 1L7, Canada
Luke Skinner
Sanofi Pasteur, 410 Thames Valley Park Dr, Earley, Reading RG6 1RH, United Kingdom
Edward Thommes
Vaccine Epidemiology and Modeling, Sanofi Pasteur, 1 Discovery Dr, Swiftwater, PA 18370, United States; Department of Mathematics & Statistics, University of Guelph, 50 Stone Road East, Guelph, ON N1G 2W1, Canada
Hélène Bricout
Sanofi Pasteur, 14 Espace Henry Vallée, 69007 Lyon, France
Paul Grootendorst
Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St, Toronto, ON M5S 3M2, Canada
We sought to gain insights into the determinants of seasonal influenza vaccine (SIV) uptake by conducting an age-stratified analysis (18–64 and 65+) of factors associated with SIV uptake among at-risk adults registered to English practices. Records for at-risk English adults between 2011 and 2016 were identified using the Clinical Practice Research Datalink database. SIV uptake was assessed annually. The associations of patient, practice, and seasonal characteristics with SIV uptake were assessed via cross-sectional and longitudinal analyses, using mixed-effects and general estimating equation logistic regression models. Overall SIV uptake was 35.3% and 74.0% for adults 18–64 and 65+, respectively. Relative to white patients, black patients were least likely to be vaccinated (OR18-64: 0.82 (95% CI: 0.80, 0.85); OR65+: 0.59 (95% CI: 0.56, 0.62)), while Asian patients among 18–64 year olds were most likely to be vaccinated (OR18-64: 1.10 (95% CI: 1.07, 1.13)). Females were more likely than males to be vaccinated among 18–64 year olds (OR18-64: 1.19 (95% CI: 1.18, 1.20)). Greater socioeconomic deprivation was associated with decreased odds of uptake among older patients (OR65+: 0.74 (95% CI: 0.71, 0.77)). For each additional at-risk condition, odds of uptake increased (OR18-64: 2.33 (95% CI: 2.31, 2.36); OR65+: 1.39 (95% CI: 1.38, 1.39)). Odds of uptake were highest among younger patients with diabetes (OR18-64: 4.25 (95% CI: 4.18, 4.32)) and older patients with chronic respiratory disease (OR65+: 1.60 (95% CI: 1.58, 1.63)), whereas they were lowest among morbidly obese patients of all ages (OR18-64: 0.68 (95% CI: 0.67, 0.70); OR65+: 0.97 (95% CI: 0.94, 0.99)). Prior influenza season severity and vaccine effectiveness were marginally predictive of uptake. Our age-stratified analysis uncovered SIV uptake disparities by ethnicity, sex, age, socioeconomic deprivation, and co-morbidities, warranting further attention by GPs and policymakers alike. Keywords: Seasonal influenza vaccine, Vaccine uptake, General practice, Determinants, Clinical Practice Research Datalink
