Factors influencing influenza, pneumococcal and shingles vaccine uptake and refusal in older adults: a population-based cross-sectional study in England
Factors influencing influenza, pneumococcal and shingles vaccine uptake and refusal in older adults: a population-based cross-sectional study in England
Objectives: uptake of influenza, pneumococcal and shingles vaccines in older adults vary across regions and socioeconomic backgrounds. In this study, we study the coverage and factors associated with vaccination uptake, as well as refusal in the unvaccinated population and their associations with ethnicity, deprivation, household size and health conditions.
Design, setting and participants: this is a cross-sectional study of adults aged 65 years or older in England, using a large primary care database. Associations of vaccine uptake and refusal in the unvaccinated with ethnicity, deprivation, household size and health conditions were modelled using multivariable logistic regression.
Outcome measure: influenza, pneumococcal and shingles vaccine uptake and refusal (in the unvaccinated).
Results: this study included 2 054 463 patients from 1318 general practices. 1 711 465 (83.3%) received at least one influenza vaccine, 1 391 228 (67.7%) pneumococcal vaccine and 690 783 (53.4%) shingles vaccine. Compared with White ethnicity, influenza vaccine uptake was lower in Chinese (OR 0.49; 95% CI 0.45 to 0.53), 'Other ethnic' groups (0.63; 95% CI 0.60 to 0.65), black Caribbean (0.68; 95% CI 0.64 to 0.71) and black African (0.72; 95% CI 0.68 to 0.77). There was generally lower vaccination uptake among more deprived individuals, people living in larger household sizes (three or more persons) and those with fewer health conditions. Among those who were unvaccinated, higher odds of refusal were associated with the black Caribbean ethnic group and marginally with increased deprivation, but not associated with higher refusal in those living in large households or those with lesser health conditions.
Conclusion: certain ethnic minority groups, deprived populations, large households and 'healthier' individuals were less likely to receive a vaccine, although higher refusal was only associated with ethnicity and deprivation but not larger households nor healthier individuals. Understanding these may inform tailored public health messaging to different communities for equitable implementation of vaccination programmes.
Epidemiology, EPIDEMIOLOGY, PRIMARY CARE, Public health
Tan, Pui San
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Patone, Martina
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Clift, Ashley Kieran
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Dambha-Miller, Hajira
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Saatci, Defne
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Ranger, Tom A
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Garriga, Cesar
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Zaccardi, Francesco
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Shah, Baiju R.
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Coupland, Carol
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Griffin, Simon J.
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Khunti, Kamlesh
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Hippisley-Cox, Julia
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16 March 2023
Tan, Pui San
66f64b43-84a2-4362-afdd-f68e410f6571
Patone, Martina
51bbd4cc-1c19-4a64-a0c2-1534b076fa79
Clift, Ashley Kieran
b36d3e2a-7236-4767-ae10-0ee97b3026f9
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Saatci, Defne
21cdc621-8420-4437-8f3e-1e41cf4ebf5b
Ranger, Tom A
d7ca11dc-975e-4e65-a5e9-cafa98076472
Garriga, Cesar
fa2cba58-6872-45dc-97b8-e4005bca1601
Zaccardi, Francesco
8d31a980-3db1-4477-9514-c18087cf886a
Shah, Baiju R.
a1e92ef6-9367-4aa5-b73f-807534eb2036
Coupland, Carol
6efd69d5-8f84-45ac-9777-d4b07feeb2e2
Griffin, Simon J.
1f8d5095-3c10-4973-a2c4-84ce6415d118
Khunti, Kamlesh
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Hippisley-Cox, Julia
7be524e3-9066-4179-b58f-cb2e16cd02ec
Tan, Pui San, Patone, Martina, Clift, Ashley Kieran, Dambha-Miller, Hajira, Saatci, Defne, Ranger, Tom A, Garriga, Cesar, Zaccardi, Francesco, Shah, Baiju R., Coupland, Carol, Griffin, Simon J., Khunti, Kamlesh and Hippisley-Cox, Julia
(2023)
Factors influencing influenza, pneumococcal and shingles vaccine uptake and refusal in older adults: a population-based cross-sectional study in England.
BMJ Open, 13 (3), [e058705].
(doi:10.1136/bmjopen-2021-058705).
Abstract
Objectives: uptake of influenza, pneumococcal and shingles vaccines in older adults vary across regions and socioeconomic backgrounds. In this study, we study the coverage and factors associated with vaccination uptake, as well as refusal in the unvaccinated population and their associations with ethnicity, deprivation, household size and health conditions.
Design, setting and participants: this is a cross-sectional study of adults aged 65 years or older in England, using a large primary care database. Associations of vaccine uptake and refusal in the unvaccinated with ethnicity, deprivation, household size and health conditions were modelled using multivariable logistic regression.
Outcome measure: influenza, pneumococcal and shingles vaccine uptake and refusal (in the unvaccinated).
Results: this study included 2 054 463 patients from 1318 general practices. 1 711 465 (83.3%) received at least one influenza vaccine, 1 391 228 (67.7%) pneumococcal vaccine and 690 783 (53.4%) shingles vaccine. Compared with White ethnicity, influenza vaccine uptake was lower in Chinese (OR 0.49; 95% CI 0.45 to 0.53), 'Other ethnic' groups (0.63; 95% CI 0.60 to 0.65), black Caribbean (0.68; 95% CI 0.64 to 0.71) and black African (0.72; 95% CI 0.68 to 0.77). There was generally lower vaccination uptake among more deprived individuals, people living in larger household sizes (three or more persons) and those with fewer health conditions. Among those who were unvaccinated, higher odds of refusal were associated with the black Caribbean ethnic group and marginally with increased deprivation, but not associated with higher refusal in those living in large households or those with lesser health conditions.
Conclusion: certain ethnic minority groups, deprived populations, large households and 'healthier' individuals were less likely to receive a vaccine, although higher refusal was only associated with ethnicity and deprivation but not larger households nor healthier individuals. Understanding these may inform tailored public health messaging to different communities for equitable implementation of vaccination programmes.
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e058705.full
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Accepted/In Press date: 18 July 2022
Published date: 16 March 2023
Additional Information:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords:
Epidemiology, EPIDEMIOLOGY, PRIMARY CARE, Public health
Identifiers
Local EPrints ID: 476594
URI: http://eprints.soton.ac.uk/id/eprint/476594
ISSN: 2044-6055
PURE UUID: 5043e8e5-10cb-45b8-a851-e744dd8c52e7
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Date deposited: 09 May 2023 16:58
Last modified: 17 Mar 2024 03:54
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Contributors
Author:
Pui San Tan
Author:
Martina Patone
Author:
Ashley Kieran Clift
Author:
Defne Saatci
Author:
Tom A Ranger
Author:
Cesar Garriga
Author:
Francesco Zaccardi
Author:
Baiju R. Shah
Author:
Carol Coupland
Author:
Simon J. Griffin
Author:
Kamlesh Khunti
Author:
Julia Hippisley-Cox
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