Influenza and pneumococcal vaccination coverage and associated factors in patients hospitalized with acute exacerbations of COPD in China: Findings from real-world data

Abstract

Background: Influenza and pneumococcal vaccination are a priority in patients with chronic obstructive pulmonary disease (COPD). However, limited information is available on vaccination coverage among patients with acute exacerbations of COPD (AECOPD) in China. This study aimed to determine the rates and associated factors of influenza and pneumococcal vaccination in patients hospitalized with AECOPD.

Methods: Baseline data from a national, multicenter, hospital-based study that included adult inpatients with AECOPD between 2017 and 2021 were analyzed. The outcomes of interest were the influenza vaccination in the past year and the pneumococcal vaccination in the past 5 years. To ensure national representativeness, rates were weighted according to the distribution of hospital levels and types enrolled in this study. Multivariable Poisson regression based on mixed-effects models were used to determine the associated factors. The independent variables included the region and hospital features where the participants were located, sociodemographic characteristics (age, sex, rural/urban residence, education, etc.), and clinical indicators (COPD disease history, lung function parameters, comorbidities, etc.). The treatment profiles of the vaccinated and unvaccinated participants were compared.

Results: Of 6949 eligible participants, the weighted rates of influenza/pneumococcal, influenza, and pneumococcal vaccination were 2.72% (95% confidence interval [CI]: 2.34%-3.10%), 2.09% (95% CI: 1.76%-2.43%), and 1.25% (95% CI: 0.99%-1.51%), respectively. In multivariable models, age ≥60 years (60-69 years, odds ratio [OR]: 1.90, 95% CI: 1.11-3.25; ≥80 years, OR: 2.00, 95% CI: 1.06-3.78), geographical regions (Northern China relative to Eastern China, OR: 5.09, 95% CI: 1.96-13.21), urban residence (OR: 1.69, 95% CI: 1.07-2.66), a higher education level (junior high school, OR: 1.77, 95% CI: 1.21-2.58; senior high school or above, OR: 2.61, 95% CI: 1.69-4.03), former smoking (OR: 1.79, 95% CI: 1.15-2.79), and regular inhaled medication treatment (OR: 3.28, 95% CI: 2.29-4.70) were positively associated with vaccination. Patients who had experienced severe exacerbations in the past year were less likely to be vaccinated (OR: 0.65, 95% CI: 0.45-0.96). Compared with unvaccinated participants, vaccinated participants adhered better to pharmacological and non-pharmacological treatment.

Conclusions: Influenza and pneumococcal vaccination coverage are extremely low. Urgent measures are necessary to increase vaccination coverage among inpatients with AECOPD in China.

Figure 1

Flowchart for the enrollment of the study participants. ACURE: Acute Exacerbations of Chronic Obstructive Pulmonary Disease Inpatient Registry; AECOPD: Acute exacerbations of chronic obstructive pulmonary disease.

Figure 2

Multivariable analysis for associated factors of influenza or pneumococcal vaccination among patients with AECOPD. AECOPD: Acute exacerbations of chronic obstructive pulmonary disease; CI: Confidence intervals; GOLD 1: Post-bronchodilator percentage predicted forced expiratory volume in one second (FEV₁%pred) ≥80%; GOLD 2: 50% ≤FEV₁%pred <80%; GOLD 3: 30% ≤FEV₁%pred <50%; GOLD 4: FEV₁%pred <30%; GOLD: Global Initiative for Chronic Obstructive Lung Disease; OR: Odds ratio.

Figure 3

Multivariable analysis for associated factors of influenza vaccination among patients with AECOPD. AECOPD: Acute exacerbations of chronic obstructive pulmonary disease; CI: Confidence intervals; GOLD 1: Post-bronchodilator percentage predicted forced expiratory volume in one second (FEV₁%pred) ≥80%; GOLD 2: 50% ≤FEV₁%pred <80%; GOLD 3: 30% ≤FEV₁%pred <50%; GOLD 4: FEV₁%pred <30%; GOLD: Global Initiative for Chronic Obstructive Lung Disease; OR: Odds ratio.

Figure 4

Multivariable analysis for associated factors of pneumococcal vaccination among patients with AECOPD. AECOPD: Acute exacerbations of chronic obstructive pulmonary disease; CI: Confidence intervals; GOLD 1: Post-bronchodilator percentage predicted forced expiratory volume in one second (FEV₁%pred) ≥80%; GOLD 2: 50% ≤FEV₁%pred <80%; GOLD 3: 30% ≤FEV₁%pred <50%; GOLD 4: FEV₁%pred <30%; GOLD: Global Initiative for Chronic Obstructive Lung Disease; OR: Odds ratio.