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Influenza-associated hospitalisation, vaccine uptake and socioeconomic deprivation in an English city region: an ecological study.

ABSTRACT: OBJECTIVES:Every year, influenza poses a significant burden on the National Health Service in England. Influenza vaccination is an effective measure to prevent severe disease, hence, maximising vaccine coverage in the most vulnerable is a priority. We aimed to identify the extent to which socioeconomic status is associated with influenza-associated illness (IAI) and influenza vaccine coverage. DESIGN:Retrospective observational study using hospital episode statistics. SETTING:Merseyside, North-West of England, including the city of Liverpool. PARTICIPANTS:Residents of Merseyside hospitalised with IAI between April 2004 and March 2016, and Merseyside general practice registered patients eligible for influenza vaccination in 2014/2015 and 2015/2016 influenza seasons. EXPOSURES:Socioeconomic deprivation based on lower super output area English Indices of Deprivation scores. PRIMARY AND SECONDARY OUTCOME MEASURES:Incidence and risk of IAI hospitalisation, and vaccine uptake. RESULTS:There were 89?058 hospitalisations related to IAI among Merseyside residents (mean yearly rate=4.9 per 1000 population). Hospitalisations for IAI were more frequent in the most socioeconomically deprived areas compared with the least deprived in adults aged 15-39 years (incidence rate ratio (IRR) 2.08;95%?CI 1.76 to 2.45; p<0.001), 60-64 years (IRR 2.65; 95%?CI 2.35 to 2.99; p<0.001) and 65+ years (IRR 1.90; 95%?CI 1.73 to 2.10; p<0.001), whereas rates in children were more homogeneous across deprivation strata. Vaccine uptake was lower than the nationally set targets in most neighbourhoods. The odds of vaccine uptake were 30% lower (OR 0.70; 95%?CI 0.66 to 0.74; p<0.001) and 10% lower (OR 0.90; 95%?CI 0.88 to 0.92; p<0.001) in the most socioeconomically deprived quintile compared with the least deprived, among children aged 24-59 months and 65+ years, respectively. CONCLUSIONS:Higher rates of IAI hospitalisations and lower vaccine uptake in the most socioeconomically deprived populations suggest that health promotion policies and interventions that target these populations should be a priority.

SUBMITTER: Hungerford D

PROVIDER: S-EPMC6303586 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Influenza-associated hospitalisation, vaccine uptake and socioeconomic deprivation in an English city region: an ecological study.

Hungerford Daniel D Ibarz-Pavon Ana A Cleary Paul P French Neil N

BMJ open 20181219 12

<h4>Objectives</h4>Every year, influenza poses a significant burden on the National Health Service in England. Influenza vaccination is an effective measure to prevent severe disease, hence, maximising vaccine coverage in the most vulnerable is a priority. We aimed to identify the extent to which socioeconomic status is associated with influenza-associated illness (IAI) and influenza vaccine coverage.<h4>Design</h4>Retrospective observational study using hospital episode statistics.<h4>Setting</ ...[more]

PMID: 30573483

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Project description:BackgroundThere 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 findingsWe 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.ConclusionsThe 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.

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Influenza-associated hospitalisation, vaccine uptake and socioeconomic deprivation in an English city region: an ecological study.

Publications

Influenza-associated hospitalisation, vaccine uptake and socioeconomic deprivation in an English city region: an ecological study.

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