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. 2018 Jun 14;36(25):3635-3640.
doi: 10.1016/j.vaccine.2018.05.021. Epub 2018 May 7.

Multimorbidity is associated with uptake of influenza vaccination

Samantha M Harrison  1 , Melissa Y Wei  2 , Lois E Lamerato  3 , Joshua G Petrie  4 , Emily Toth Martin  5
Affiliations

Multimorbidity is associated with uptake of influenza vaccination

Samantha M Harrison et al. Vaccine. .

Abstract

Objective: Patients with chronic conditions have higher rates of severe influenza-related illness and mortality. However, influenza vaccination coverage in high-risk populations continues to be suboptimal. We describe the association between cumulative disease morbidity, measured by a previously validated multimorbidity index, and influenza vaccination among community-dwelling adults.

Methods: We obtained interview and medical record data for participants ≥18 years who sought outpatient care for influenza-like illness between 2011 and 2016 as part of an outpatient-based study of influenza vaccine effectiveness. We defined cumulative disease morbidity by using medical diagnosis codes to calculate a multimorbidity-weighted index (MWI) for each participant. MWI and influenza vaccination status was evaluated by logistic regression. Akaike information criterion was calculated for all models.

Results: Overall, 1458 (48%) of participants out of a total of 3033 received influenza vaccination. The median MWI was 0.9 (IQR 0.00-3.5) and was higher among vaccinated participants (median 1.6 versus 0.0; p < 0.001). We found a positive linear association between MWI and vaccination, and vaccination percentages were compared between categories of MWI. Compared to patients with no multimorbidity (MWI = 0), odds of vaccination were 17% higher in the second category (MWI 0.01-1.50; [OR: 1.17, 95% CI: 0.92-1.50]), 58% higher in the third category (MWI 1.51-3.00; [OR: 1.58, 95% CI: 1.26-1.99]), 130% higher in the fourth category (MWI 3.01-6.00; [OR: 2.30, 95% CI: 1.78-2.98]) and 214% higher in the fifth category (MWI 6.01-45.00;[OR: 3.14, 95% CI: 2.41-4.10]). Participants defined as high-risk had 86% greater odds of being vaccinated than non-high-risk individuals (OR: 1.86, 95% CI: 1.56-2.21). The AIC was lowest for MWI compared with high-risk conditions.

Conclusions: Our results suggest a dose response relationship between level of multimorbidity and likelihood of influenza vaccination. Compared with high-risk condition designations, MWI provided improved precision and a better model fit for the measurement of chronic disease and influenza vaccination.

Keywords: Chronic disease; Influenza; Multimorbidity; Vaccination.

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Conflict of interest statement

Conflicts of interest

None reported, all authors.

All authors attest they meet the ICMJE criteria for authorship.

Figures

Fig. 1.
Fig. 1.
Percent with influenza vaccination by MWI category, overall and by high risk status. Markers indicate percent vaccinated in a specified MWI category overall (black) and by high risk status (gray). Lines indicate exact confidence interval.
See this image and copyright information in PMC

References

    1. Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep 2006;55:1–42. - PubMed
    1. Petrie JG, Ohmit SE, Cheng CK, Martin ET, Malosh RE, Lauring AS, et al. Influenza vaccine effectiveness against antigenically drifted influenza higher than expected in hospitalized adults: 2014–2015. Clin Infect Dis Off Publ Infect Dis Soc Am 2016;63:1017–25. https://doi.org/10.1093/cid/ciw432. - DOI - PubMed
    1. Garg S, Jain S, Dawood FS, Jhung M, Pérez A, D’Mello T, et al. Pneumonia among adults hospitalized with laboratory-confirmed seasonal influenza virus infection—United States, 2005–2008. BMC Infect Dis 2015;15 10.1186/s12879-015-1004-y. - DOI - PMC - PubMed
    1. Grohskopf LA, Sokolow LZ, Broder KR, Olsen SJ, Karron RA, Jernigan DB, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the advisory Committee on Immunization Practices — United States, 2016–17 Influenza Season. MMWR Recomm Rep 2016;65:1–54. https://doi.org/10.15585/mmwr.rr6505a1. - DOI - PubMed
    1. Lu P, O’Halloran A, Ding H, Srivastav A, Williams WW. Uptake of influenza vaccination and missed opportunities among adults with high-risk conditions, United States, 2013. Am J Med 2016;129:636.e1–636.e11. 10.1016/j.amjmed.2015.10.031. - DOI - PMC - PubMed

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