Evaluating socioeconomic inequalities in influenza vaccine uptake during the COVID-19 pandemic: A cohort study in Greater Manchester, England.

Autor: Watkinson RE; NIHR Applied Research Collaboration Greater Manchester / Health Organisation, Policy, and Economics (HOPE) Group, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom., Williams R; NIHR Greater Manchester Patient Safety Translational Research Centre and NIHR Applied Research Collaboration Greater Manchester, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom., Gillibrand S; NIHR Applied Research Collaboration Greater Manchester / Health Organisation, Policy, and Economics (HOPE) Group, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom., Munford L; NIHR Applied Research Collaboration Greater Manchester / Health Organisation, Policy, and Economics (HOPE) Group, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom., Sutton M; NIHR Applied Research Collaboration Greater Manchester / Health Organisation, Policy, and Economics (HOPE) Group, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom.
Jazyk: angličtina
Zdroj: PLoS medicine [PLoS Med] 2023 Sep 26; Vol. 20 (9), pp. e1004289. Date of Electronic Publication: 2023 Sep 26 (Print Publication: 2023).
DOI: 10.1371/journal.pmed.1004289
Abstrakt: Background: There are known socioeconomic inequalities in annual seasonal influenza (flu) vaccine uptake. The Coronavirus Disease 2019 (COVID-19) pandemic was associated with multiple factors that may have affected flu vaccine uptake, including widespread disruption to healthcare services, changes to flu vaccination eligibility and delivery, and increased public awareness and debate about vaccination due to high-profile COVID-19 vaccination campaigns. However, to the best of our knowledge, no existing studies have investigated the consequences for inequalities in flu vaccine uptake, so we aimed to investigate whether socioeconomic inequalities in flu vaccine uptake have widened since the onset of the COVID-19 pandemic.
Methods and Findings: We used deidentified data from electronic health records for a large city region (Greater Manchester, population 2.8 million), focusing on 3 age groups eligible for National Health Service (NHS) flu vaccination: preschool children (age 2 to 3 years), primary school children (age 4 to 9 years), and older adults (age 65 years plus). The sample population varied between 418,790 (2015/16) and 758,483 (2021/22) across each vaccination season. We estimated age-adjusted neighbourhood-level income deprivation-related inequalities in flu vaccine uptake using Cox proportional hazards models and the slope index of inequality (SII), comparing 7 flu vaccination seasons (2015/16 to 2021/22). Among older adults, the SII (i.e., the gap in uptake between the least and most income-deprived areas) doubled over the 7 seasons from 8.48 (95% CI [7.91,9.04]) percentage points to 16.91 (95% CI [16.46,17.36]) percentage points, with approximately 80% of this increase occurring during the pandemic. Before the pandemic, income-related uptake gaps were wider among children, ranging from 15.59 (95% CI [14.52,16.67]) percentage points to 20.07 (95% CI [18.94,21.20]) percentage points across age groups and vaccination seasons. Among preschool children, the uptake gap increased in 2020/21 to 25.25 (95% CI [24.04,26.45]) percentage points, before decreasing to 20.86 (95% CI [19.65,22.05]) percentage points in 2021/22. Among primary school children, inequalities increased in both pandemic years to reach 30.27 (95% CI [29.58,30.95]) percentage points in 2021/22. Although vaccine uptake increased during the pandemic, disproportionately larger increases in uptake in less deprived areas created wider inequalities in all age groups. The main limitation of our approach is the use of a local dataset, which may limit generalisability to other geographical settings.
Conclusions: The COVID-19 pandemic led to increased inequalities in flu vaccine uptake, likely due to changes in demand for vaccination, new delivery models, and disruptions to healthcare and schooling. It will be important to investigate the causes of these increased inequalities and to examine whether these increased inequalities also occurred in the uptake of other routine vaccinations. These new wider inequalities in flu vaccine uptake may exacerbate inequalities in flu-related morbidity and mortality.
Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: MS is a National Institute for Health and Care Research (NIHR) Senior Investigator, whose collective role is to: contribute significantly to NIHR as a senior leader; lead in training and development of NIHR’s people; act as an ambassador for the NIHR in the wider system; demonstrate research excellence; contribute to growth; integrate patient, care users, carers and public involvement and engagement in research; and play a leading role in NIHR’s contribution to growth. Each Senior Investigator receives a discretionary award of £20,000 per year of appointment to fund activities that support their research. Within the last five years, MS has had the following roles for NIHR: National Lead for Economics in the NIHR Applied Research Collaborations, Chair of the Economics Workstream for the NIHR Methodology Incubator, Chair of the NIHR Economics Group; Member of the National Institute for Health and Care Excellence (NICE) Implementation Strategy Group; Member of the Rapid Service Evaluation Team 2023 Committee; Member of the School for Social Care Phase IV Committee; Deputy Chair of the NIHR Advanced Fellowships Panel; Deputy Chair of the NIHR Health Services and Delivery Research Funding Committee; Member of the NIHR Clinician Scientist Fellowship Panel; Member of the Department of Health Policy Research Programme Board; and Member of five Study Steering Committees. All other authors have declared that no competing interests exist.
(Copyright: © 2023 Watkinson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje