tetano
Editor, Senior Moderator
Med Care. 2013 Aug 21. [Epub ahead of print]
Hospitalization and Skilled Nursing Care are Predictors of Influenza Vaccination Among Patients on Hemodialysis: Evidence of Confounding by Frailty.
McGrath LJ, Cole SR, Kshirsagar AV, Weber DJ, St?rmer T, Brookhart MA.
Source
Departments of *Epidemiology, Gillings School of Global Public Health ?Medicine, Division of Nephrology and Hypertension ?Medicine, Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
Abstract
BACKGROUND::
Observational studies of preventive medications, such as vaccinations, can suffer from the healthy-user bias because vaccinated patients may be healthier than unvaccinated patients. Indicators of health status and frailty suitable for attenuating this bias could be identified in administrative data.
OBJECTIVE::
To examine the association of baseline variables and time-dependent hospitalization and skilled nursing care with the receipt of influenza vaccination in patients with end-stage renal disease.
RESEARCH DESIGN::
Observational cohort study using United States Renal Data System files each year from 1999 to 2005.
SUBJECTS::
Population-based cohorts that included >115,000 adult, hemodialysis patients each year.
MEASURES::
We estimated hazard ratios for the association of baseline variables and time-dependent hospitalization days and skilled nursing days with influenza vaccination, controlling for demographic and baseline health status variables.
RESULTS::
Vaccination coverage increased from 47% in 1999 to 60% in 2005. Patients with any length of hospitalization were less likely to be vaccinated, however, the association was stronger in patients with longer stays [15-25 d: hazard ratio=0.64 (95% confidence interval, 0.62-0.65); 26-30 d: 0.40 (0.38-0.42)]. Patients with any length of skilled nursing care of >1 day had similar estimates; these patients were also less likely to be vaccinated [26-30 d: 0.66 (0.64-0.69)].
CONCLUSIONS::
Patients with long hospitalizations or skilled nursing stays were less likely to be vaccinated suggesting evidence of the healthy-user effect. These variables could be used to account for bias in studies of preventive services in patients on dialysis.
PMID:
23969584
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/23969584
Hospitalization and Skilled Nursing Care are Predictors of Influenza Vaccination Among Patients on Hemodialysis: Evidence of Confounding by Frailty.
McGrath LJ, Cole SR, Kshirsagar AV, Weber DJ, St?rmer T, Brookhart MA.
Source
Departments of *Epidemiology, Gillings School of Global Public Health ?Medicine, Division of Nephrology and Hypertension ?Medicine, Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.
Abstract
BACKGROUND::
Observational studies of preventive medications, such as vaccinations, can suffer from the healthy-user bias because vaccinated patients may be healthier than unvaccinated patients. Indicators of health status and frailty suitable for attenuating this bias could be identified in administrative data.
OBJECTIVE::
To examine the association of baseline variables and time-dependent hospitalization and skilled nursing care with the receipt of influenza vaccination in patients with end-stage renal disease.
RESEARCH DESIGN::
Observational cohort study using United States Renal Data System files each year from 1999 to 2005.
SUBJECTS::
Population-based cohorts that included >115,000 adult, hemodialysis patients each year.
MEASURES::
We estimated hazard ratios for the association of baseline variables and time-dependent hospitalization days and skilled nursing days with influenza vaccination, controlling for demographic and baseline health status variables.
RESULTS::
Vaccination coverage increased from 47% in 1999 to 60% in 2005. Patients with any length of hospitalization were less likely to be vaccinated, however, the association was stronger in patients with longer stays [15-25 d: hazard ratio=0.64 (95% confidence interval, 0.62-0.65); 26-30 d: 0.40 (0.38-0.42)]. Patients with any length of skilled nursing care of >1 day had similar estimates; these patients were also less likely to be vaccinated [26-30 d: 0.66 (0.64-0.69)].
CONCLUSIONS::
Patients with long hospitalizations or skilled nursing stays were less likely to be vaccinated suggesting evidence of the healthy-user effect. These variables could be used to account for bias in studies of preventive services in patients on dialysis.
PMID:
23969584
[PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/23969584