Inequalities in uptake of influenza vaccine by deprivation and risk group: Time trends analysis
Introduction
Influenza and its related illnesses remain a major cause of preventable morbidity and mortality in the elderly worldwide [1]. Influenza can also be a serious health problem to people in high-risk groups who already suffer from chronic diseases such as diabetes mellitus, chronic heart disease, respiratory disease and renal disease.
Immunisation against influenza is an important means of reducing morbidity and mortality amongst patients at high risk including the elderly [2]. Since the late 1960s influenza vaccination has been recommended in the United Kingdom (UK) for patients of all ages from selected high-risk groups, including the elderly with underlying medical conditions as well as those living in long stay residential homes where the spread of influenza is likely to be rapid. In 1998 influenza vaccination was recommended for all persons aged 75 years and over regardless of predisposing risk conditions. In 2000 this policy was modified to include all persons aged 65 years and over. The risk group categories in people aged under 65 years have also been expanded over time in an attempt to reduce the morbidity from influenza in these groups. Improvement in the delivery of influenza vaccination is seen as an important aspect of preventive care for primary healthcare teams [3]. A target for uptake of the vaccine in older people was introduced by the Department of Health in 2000/2001. Initially this was set at 60%, rising to 65% the following year and 70% in 2002/2003 and subsequent years.
Studies have been conducted in the UK and Europe looking at the uptake of the influenza vaccine amongst the elderly and in the high-risk groups [4], [5], [6], [7]. A rapid reporting scheme was introduced in England to ascertain uptake in people aged 65 and over in the winters of 2000/2001. Monthly data on vaccination uptake showed that Department of Health target rates were met but also showed that there was considerable variation in uptake at local levels [2]. Local differences in vaccination uptake may be due to a number of factors including socio-economic deprivation, ethnicity and rurality, if that were the case local and national campaigns to increase uptake may need to take these factors into account. However there has been relatively little research into the effect of socio-economic status, rurality or ethnicity on the uptake of influenza immunisation [8]. A study looking at uptake rates in 73 British practices [4] between 1997 and 2000 found that influenza immunisation uptake was lower amongst women, people aged 85 years and over compared to people aged under 80, and those in most deprived areas compared to the least deprived. However this study was restricted to people aged 75 and over, and only covered a relatively short time period.
This research project used information from 413 practices contributing to the QRESEARCH database to investigate influenza immunisation rates in the UK in patients of all ages over a period of 6 years and examined trends in uptake by sex, deprivation, rurality, ethnicity of area of residence and risk group.
Section snippets
Materials and methods
We used the QRESEARCH primary care database to undertake this study. The full QRESEARCH database (http://www.qresearch.org/) currently contains the anonymised primary care clinical records of over 10 million people registered at any time in the last 16 years with 525 UK general practices. Consent to provide data for QRESEARCH was sought from all UK practices using the EMIS medical records system. The consenting practices form a representative sample of 6% of all of all UK general practices, and
Study population
There were 413 practices meeting our inclusion criteria with complete data between 1 April 1999 and 1 April 2005. There were 2.9 million registered patients in these practices on 1 April 2005 who had also been registered for the whole of the preceding 3 months. Of these, 504,362 patients (17.2%) had been vaccinated with influenza vaccine between 1 September 2004 and 31 March 2005 (Table 1). This represents a relative increase of 59.5% compared with the proportion of the total population
Discussion
This paper reports findings from a large population-based study designed to examine trends in the uptake of influenza vaccination over a 6-year period in primary care. There was a marked increase (59.5%) in the overall population uptake of influenza vaccine over the 6-year period and a 62.5% increase in uptake in people aged 65 years and over, with 70% vaccinated in 2004/2005. In 2004/2005 however only 29% of all patients in a clinical risk group aged less than 65 were vaccinated. Overall
Acknowledgements
We thank the practices contributing to the QRESEARCH database and David Stables (EMIS computing) for support in setting QRESEARCH up. We thank Gavin Langford for the data extraction.
Contributors: CC designed and carried out the statistical analysis, contributed to the interpretation and drafting of the paper. SH contributed to the initial study design, data definitions, analysis, drafting and interpretation. GS originated the idea for the study, contributed to the design, analysis plan,
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