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Editor, Senior Moderator
BMJ Open. 2018 Dec 19;8(12):e023275. doi: 10.1136/bmjopen-2018-023275.
[h=1]Influenza-associated hospitalisation, vaccine uptake and socioeconomic deprivation in an English city region: an ecological study.[/h] Hungerford D[SUP]1,[/SUP][SUP]2[/SUP], Ibarz-Pavon A[SUP]1[/SUP], Cleary P[SUP]2[/SUP], French N[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] 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.
[h=4]DESIGN:[/h] Retrospective observational study using hospital episode statistics.
[h=4]SETTING:[/h] Merseyside, North-West of England, including the city of Liverpool.
[h=4]PARTICIPANTS:[/h] 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.
[h=4]EXPOSURES:[/h] Socioeconomic deprivation based on lower super output area English Indices of Deprivation scores.
[h=4]PRIMARY AND SECONDARY OUTCOME MEASURES:[/h] Incidence and risk of IAI hospitalisation, and vaccine uptake.
[h=4]RESULTS:[/h] 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.
[h=4]CONCLUSIONS:[/h] 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.
? Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
[h=4]KEYWORDS:[/h] ecological; epidemiology; inequalities; influenza; public health; vaccination
PMID: 30573483 DOI: 10.1136/bmjopen-2018-023275
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[h=1]Influenza-associated hospitalisation, vaccine uptake and socioeconomic deprivation in an English city region: an ecological study.[/h] Hungerford D[SUP]1,[/SUP][SUP]2[/SUP], Ibarz-Pavon A[SUP]1[/SUP], Cleary P[SUP]2[/SUP], French N[SUP]1[/SUP].
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] 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.
[h=4]DESIGN:[/h] Retrospective observational study using hospital episode statistics.
[h=4]SETTING:[/h] Merseyside, North-West of England, including the city of Liverpool.
[h=4]PARTICIPANTS:[/h] 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.
[h=4]EXPOSURES:[/h] Socioeconomic deprivation based on lower super output area English Indices of Deprivation scores.
[h=4]PRIMARY AND SECONDARY OUTCOME MEASURES:[/h] Incidence and risk of IAI hospitalisation, and vaccine uptake.
[h=4]RESULTS:[/h] 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.
[h=4]CONCLUSIONS:[/h] 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.
? Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY. Published by BMJ.
[h=4]KEYWORDS:[/h] ecological; epidemiology; inequalities; influenza; public health; vaccination
PMID: 30573483 DOI: 10.1136/bmjopen-2018-023275
Free full text