Multimorbidity is associated with uptake of influenza vaccination.

Autor: Harrison SM; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA. Electronic address: samharri@umich.edu., Wei MY; Division of General Medicine, Michigan Medicine, 2800 Plymouth Rd Bldg 16, Ann Arbor, MI 48109-2800, USA. Electronic address: weimy@med.umich.edu., Lamerato LE; Henry Ford Health System, One Ford Place, 5C, Detroit, MI 48202 USA. Electronic address: LLAMERA1@hfhs.org., Petrie JG; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA. Electronic address: jpetrie@umich.edu., Toth Martin E; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA. Electronic address: etmartin@umich.edu.
Jazyk: angličtina
Zdroj: Vaccine [Vaccine] 2018 Jun 14; Vol. 36 (25), pp. 3635-3640. Date of Electronic Publication: 2018 May 07.
DOI: 10.1016/j.vaccine.2018.05.021
Abstrakt: 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.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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