Elsevier

Preventive Medicine

Volume 55, Issue 3, September 2012, Pages 246-250
Preventive Medicine

Factors associated with continued adherence to influenza vaccination in the elderly

https://doi.org/10.1016/j.ypmed.2012.06.020Get rights and content

Abstract

Objective

We aimed to analyze the factors influencing continued adherence to influenza vaccination in elderly persons vaccinated in the preceding season.

Methods

Using a population-based vaccination registry, we evaluated the proportion of persons vaccinated against influenza in Navarre, Spain, in the 2010–11 season among non-institutionalized persons aged 65 years or over who had been vaccinated in the 2009–10 season. Logistic regression was used to analyze the influence of sociodemographic, clinical and health care factors.

Results

Of the 64,245 persons vaccinated against influenza in the 2009–10 season, 87% were vaccinated in the 2010–11 season. Continued adherence to vaccination increased with the number of physician visits per year. It was lower in women, in the 65–69 and ≥ 95 year age-groups, in those hospitalized or diagnosed with any major chronic condition in the previous year, and in persons with hematological cancer or dementia. Health districts and physicians with higher coverage in the previous season continued to have higher adherence in the following season.

Conclusions

People vaccinated against influenza in one season tend to be vaccinated in the following one. Sociodemographic, clinical and health care factors have a moderate effect on the continuity of vaccination, with the most important factor being the treating physician.

Highlights

► We analyzed continued adherence to influenza vaccination in the elderly. ► People previously vaccinated tend to be vaccinated in the following season. ► Recent hospitalization was associated with discontinuing vaccination. ► The treating physician was the most important factor for continuity of vaccination.

Introduction

Recommendations for preventing the morbidity and mortality due to seasonal influenza include annual vaccination of all people aged 65 and over (Fiore et al., 2010). However, the vaccine coverage reached in this population group is far from the 75% target proposed by the World Health Assembly for 2010 (Davidson et al., 2003, World Health Organization, 2003). This highlights the importance of identifying possible ways to widen coverage. Interventions to improve vaccination coverage should emphasize two points: attracting people who do not usually get vaccinated and retaining those who have been vaccinated in previous seasons.

Several studies have described the variables that are associated with influenza vaccination, including sociodemographic, clinical and physician-dependent factors (Abramson and Levi, 2008, Blank et al., 2008, Blank et al., 2009, Chiatti et al., 2011, Frank et al., 1985, Sarriá-Santamera and Timoner, 2003).

Population-based vaccination registries have been shown to be useful in identifying areas with the potential to improve vaccination coverage and in monitoring the results of vaccination campaigns (Centers for Disease Control and Prevention, 2001, Kempe et al., 2004, Rodríguez-Rieiro et al., 2010). In Navarre, Spain, this methodology showed that continual improvements in influenza vaccination coverage among persons aged 65 and over were achieved between the 2006–07 and 2009–10 seasons, but this trend was reversed between the 2009–10 and 2010–11 seasons when coverage fell from 63% to 59%, whereas there was no change in the vaccination program. Continued adherence to influenza vaccination is critical to maintaining high coverage in successive seasons in population groups for whom the vaccine is indicated. Accordingly, we proposed to analyze the factors influencing continued adherence to influenza vaccination in the 2010–11 season among non-institutionalized persons aged 65 years and over who had been vaccinated in the previous season.

Section snippets

Setting, sources of information and influenza vaccination campaign

The Regional Health Service of Navarre, Spain, provides free health care to approximately 97% of the population of the region (636,924 inhabitants). The population is distributed according to place of residence into health districts, each of which has a health care center. A team of 4 to 14 primary care physicians provides medical consultations in each center and coordinates preventive programs. An average of 1176 persons is assigned to each physician who directs all their health care. In 2004

Results

The study included the 64,245 non-institutionalized persons aged 65 and over who had been vaccinated against seasonal influenza in the 2009–10 season. Some 56% were women, and 84% were between 65 and 84 years of age, with a mean age (± standard deviation) of 76.7 (± 7.4) years. About 63% had some type of chronic disease.

Overall, 87% continued to be vaccinated against influenza in the 2010–11 season, a percentage that varied moderately depending on some of the variables analyzed. It was lower in

Discussion

The results show high continued adherence (87%) to influenza vaccination among non-institutionalized persons aged 65 and over who had received the vaccine in the previous season. The fact that the Navarre Health Service recommends the influenza vaccine and offers it free to the entire population aged 65 and over probably contributed to this high adherence, and suggests that health system factors related to patients’ access to vaccination are unlikely to have played an important part.

Despite

Conclusions

The complex nature of this issue is reflected in the multiple causes that have been identified for failure to vaccinate and calls for a multi-faceted approach to reaching unvaccinated patients. Since people vaccinated against influenza in one season are very likely to be vaccinated in the following one, particular emphasis should be put on targeting persons in whom the vacine is indicated but who have not been vaccinated previously. To maintain good adherence to influenza vaccination it is

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgments

This work was supported by the I-MOVE (Influenza Monitoring Vaccine Effectiveness in Europe) programme funded by the European Centre for Disease Prevention and Control (ECDC), by the Carlos III Institute of Health (GR09/0028 and PS09/01179) and by the Pharmacy Directorate of the Spanish Ministry of Health (EC11-302).

References (19)

There are more references available in the full text version of this article.

Cited by (33)

  • Trajectories and individual determinants of repeated seasonal flu vaccination use over the long term using data from the French E3N cohort

    2022, Vaccine
    Citation Excerpt :

    The stability of vaccination behaviors could partly rely on contacts with physicians as there’s a key role of GPs in adherence to flu vaccination [19]. While difficulties of access have been highlighted as a barrier in the literature [18,29], having a lower access to GPs is not significantly associated with belonging to the cluster of women that never get vaccinated or enter late into vaccination. The favorable effect of being in couple could be due to the protective effect of the vaccine on the spouse, particularly if he or she is elderly or at risk, by the relay of the spouse’s recommendation of the vaccine, and to fewer difficulties in accessing the vaccine [18,21].

  • Prevalence and predictors of influenza vaccination among residents of long-term care facilities

    2019, Vaccine
    Citation Excerpt :

    There are many factors that tend to determine vaccination uptake in the general older population (both in LTCFs and in the community). These can take the form of socioeconomic and demographic factors such as sex, age, ethnicity and education level; or they can be factors such as the ready availability of information, knowledge and advice [7,24,25]. Often, these factors will greatly affect beliefs and perceptions, and ultimately the health behaviours of the population [26].

  • Construct validity of Attitudes Towards Vaccinations Scale (ATVS)–part 2

    2017, European Geriatric Medicine
    Citation Excerpt :

    In our study older people, who were vaccinated against influenza or tetanus in the past perceived more advantages and were less skeptical to vaccination compared to patients who did not take vaccine against these diseases. The meaning of the positive experience of previous vaccination has been reported in other publications concerning vaccination against influenza and pneumococcal infections [25–28]. A doctor plays the key role in motivating patients to take vaccines [2].

  • Lower vaccine uptake amongst older individuals living alone: A systematic review and meta-analysis of social determinants of vaccine uptake

    2017, Vaccine
    Citation Excerpt :

    Two studies [29,30] categorised living arrangements differently. One (comparing smaller versus larger households) reported increased uptake amongst individuals from large households [29], whereas the other (living with children versus not living with children) [30] reported lower vaccine uptake amongst those living with children. The studies that used probit or linear regression models found negative associations between vaccine uptake and housing density [31] and those living with children [14].

View all citing articles on Scopus
View full text