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Article

Do Family Physicians’ Recommendations for Influenza and Pneumococcal Vaccines Impact the Elderly Aged ≥60 Years? A Cross-Sectional Study in Six Chinese Cities

1
School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100080, China
2
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
3
Institute for Hospital Management, Tsinghua University, Shenzhen 518000, China
4
Beijing Center for Disease Prevention and Control, Beijing 100013, China
5
Nanan District Center for Disease Control and Prevention, Chongqing 400060, China
6
Shenzhen Center for Disease Control and Prevention, Shenzhen 518055, China
7
Shenzhen Nanshan District Health Committee, Shenzhen 518052, China
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Vaccines 2025, 13(8), 886; https://doi.org/10.3390/vaccines13080886 (registering DOI)
Submission received: 30 June 2025 / Revised: 10 August 2025 / Accepted: 19 August 2025 / Published: 21 August 2025
(This article belongs to the Section Vaccines and Public Health)

Abstract

Background: Influenza vaccine and pneumococcal vaccine are essential to protect the health of older adults. This study focuses on the impact of family physicians’ recommendations on influenza and pneumococcal vaccine uptake among urban Chinese older adults and makes recommendations for improving vaccination rates. Methods: A cross-sectional survey on influenza vaccination and pneumonia vaccination was conducted in December 2024 in six cities in China among adults aged ≥60 years. Marginal effects as well as logistic regression models were adopted to measure the relationship between family physician recommendation and influenza vaccination and pneumonia vaccination. Results: The overall influenza vaccination rate was 34.05% and pneumococcal vaccination rate was 22.79%. City, educational level, monthly income, health status, and family physician vaccination recommendation had significant impacts on influenza and pneumococcal vaccination (p < 0.05). Among the investigated elderly population, 48.78% and 28.56% had received recommendations from family physicians regarding influenza and pneumococcal vaccination, respectively. Analysis of marginal effects models revealed that physicians’ recommendations were significantly able to boost influenza and pneumococcal vaccination rates by 26.3% (average marginal effect = 0.263, 95% CI = 0.249–0.277) and 23.7% (average marginal effect = 0.237, 95% CI = 0.225–0.248), respectively (p < 0.001). In the adjusted model, family physician recommendation, compared with no family physician recommendation, was also associated with vaccine policy, monthly income, and age in influenza vaccine and pneumococcal vaccine uptake. Conclusions: Older adults’ influenza and pneumococcal vaccination rates need to be improved. Family physicians’ recommendations show a more significant impact on older adults. Family physician recommendations had the greatest boosting effect on vaccination among individuals aged 70–79. Healthcare providers should adopt different vaccine recommendation strategies based on the characteristics of older adults.

1. Introduction

Due to lower immune responses associated with aging, influenza and pneumococcal disease are linked to considerable morbidity and mortality in older adults [1,2,3]. Based on an estimate, influenza causes approximately 290,000–650,000 deaths annually, while pneumonia causes 2,600,000 deaths [4,5,6]. Among Chinese older adults, influenza and pneumonia also pose a serious health threat [7,8]. Preventing influenza and pneumonia is crucial for the health development of the population.
Influenza and pneumococcal vaccination are the most effective ways to prevent morbidity and mortality attributable to pneumococcal pneumonia and influenza virus, as well as to reduce economic burdens [9]. According to the World Health Organization (WHO), older adults should receive routine immunization with influenza and pneumococcal vaccines, and many countries currently follow this recommendation [10,11,12,13,14]. In China, the Chinese Center for Disease Control and Prevention (CDC) guidelines recommend influenza and pneumococcal vaccination for populations at high risk of infection and influenza-related complications among older adults [15,16]. Meanwhile, the policy of subsidizing influenza vaccines and pneumonia vaccines has been implemented in some Chinese cities with sufficient financial budgets, like Beijing and Shenzhen [17,18,19,20].
Past research has shown that factors such as age, education level, health status, and economic status influence vaccination rates [7,21,22,23]. In addition, prior studies have indicated that provider-level barriers among populations contribute to the low vaccination coverage in China [23,24]. Since the implementation of the family physician contract service, family physicians have provided health education services to elderly people in the community and have become the medical professionals most frequently encountered by the elderly [25]. In China, family physicians include physicians in primary healthcare institutions like Community Health Service Centers (CHSCs), as well as qualified physicians from township health centers, rural doctors, and physicians in the Chinese medicine category [25]. A family physician’s vaccination recommendation can directly affect older adults’ trust in vaccines and subsequent vaccination decisions. After receiving vaccination recommendations from their physicians, older adults are more motivated to get vaccinated and have increased confidence in the safety and efficacy of vaccines [17]. The vaccination status of primary care physicians and patients’ mistrust toward physicians are important factors influencing recipients’ willingness to be vaccinated [26,27]. Notably, among the elderly population, those with comorbid chronic conditions—such as hypertension, diabetes, or cardiovascular diseases—exhibit a higher propensity to follow medical advice regarding vaccinations [28]. Lack of recommendation by family physicians has been cited as one of the main reasons why pneumococcal and influenza vaccinations were rejected in previous studies. Moreover, the current involvement of general practitioners in vaccination recommendations is low in China. Few family physicians actively provide vaccination recommendations for high-risk groups such as the elderly in the past [29,30]. Current academic inquiry into the role of family physician recommendations in driving influenza and pneumonia vaccination uptake among older adults remains conspicuously underdeveloped.
This study aims to investigate the relationship between physicians’ recommendations and influenza and pneumococcal vaccination among older adults in China. Findings from this study can provide valuable insights into health policies on influenza and pneumococcal vaccination among older adults in China and contribute to efforts to improve vaccination coverage.

2. Method

2.1. Study Design and Participants

In December 2024, we conducted a cross-sectional study to collect self-reported data through field surveys in Beijing (North), Hangzhou (East), Qingdao (East), Shenzhen (South), Chongqing (Southwest), and Chengdu (Southwest), which were selected based on geographic location. In each city, five to eight Community Health Service Centers (CHSCs)—responsible for providing vaccination services to urban residents—were randomly selected using simple random sampling from a list of all local CHSCs. Each CHSCs needed to invite 300 individuals. The details can be seen in Figure 1 and Figure 2.
Elderly individuals aged 60 years and above who received free medical examinations at the CHSCs were randomly invited to participate and were surveyed when they came for health checkups or vaccinations. Interviewers approached eligible individuals consecutively in waiting areas and invited them to participate. All questionnaires were completed through face-to-face interviews conducted by trained interviewers and were configured to require completion of all items before submission. In total, 13,754 individuals were invited and completed the questionnaire. During the data processing stage, we applied strict inclusion criteria and logical consistency checks to screen the collected questionnaires and remove invalid samples that did not meet the age threshold or contained contradictory responses, thereby ensuring the validity of the dataset. A total of 13,363 valid questionnaires were ultimately included, resulting in a response validity rate of 97.2%.

2.2. Measures

The primary outcome variables were binary indicators of whether the participant had ever received the influenza vaccine and pneumococcal vaccine. Participants were asked: “Have you received influenza vaccine for adults in the past one year?” and “Have you ever received pneumococcal vaccine for adults?”. All dependent variables were binary, with response categories of “Yes” or “No”.
The key explanatory variable was family physicians’ recommendations. Participants were asked: “Has a family physician ever recommended that you receive the influenza vaccine?” and “Has a family physician ever recommended that you receive the pneumococcal vaccination?”. Responses were binary, with the response categories as “Yes” or “No”. If participants answered “No”, we classified as “no-family physician recommendation.”
The questionnaire also collected demographic characteristics and health-related information, including gender, age, ethnicity, education level, monthly income, self-reported health status, and whether the vaccine was free or self-paid. Details of the questionnaire are provided in Supplementary Material (File S1).

2.3. Statistical Analysis

Statistical analyses were performed using SPSS Version 25.0 and R Version 4.4.3. First, we estimated vaccination rates for both vaccines among older adults, as well as rates for each vaccine based on sociodemographic and health-related characteristics of the participants. A chi-square test was performed to discern differences between groups.
We then assessed the association between influenza vaccination and family physician recommendation status using an average marginal effect (AME), controlling for age category, gender, race, education level, monthly income, health status, and vaccine price. To conduct the sensitivity analysis, 50% of the sample size was repeatedly drawn from the original dataset for 200 iterations. The range of AME values was calculated, and the original AME value was compared against this range to verify its inclusion, thereby completing the analysis.
Finally, we tested for differences in vaccination rates associated with age/vaccine price/monthly income and family physician recommendation by two logistic regressions. We used R’s marginaleffects commands to calculate predicted probabilities from each model (note that estimates of unadjusted probabilities using this approach are identical to simple cross-tabulations). We then calculated the marginal effect on influenza and pneumococcal vaccination within each of the three population categories, for each age category, and for each lower income group versus the highest income category. Using estimates from our adjusted effect modification models, we calculated the differential effect of being 70–79 and ≥80 years old versus 60–69 years old, female versus male, or low and middle income versus high income among those without a family physician recommendation relative to that difference in the elderly who had received a recommendation from a family physician.

3. Result

3.1. Population Characteristics and Factors Associated with Vaccination

Table 1 displays the basic characteristics of 13,363 participants among six cities in China. Of these, 45.26% were male, and most participants were aged 60–69 years (57.46%). Additionally, 43.62% of participants reported a monthly income of CNY 2501 to 5000. Most participants rated their health status as fair (40.16%) or good (40.57%). A total of 34.05% of participants received the influenza vaccine free of charge, while 22.79% received the pneumococcal vaccine free of charge. The overall influenza vaccination rate was 34.05% and pneumococcal vaccination rate was 22.79%.
City (χ2 = 187.684, p < 0.001), educational level (χ2 = 99.695, p < 0.001), monthly income (χ2 = 157.152, p < 0.001), health status (χ2 = 15.594, p = 0.004), and family physician vaccination recommendation (χ2 = 1058.091, p < 0.001) all had significant impacts on influenza vaccination. Similarly, city (χ2 = 271.66, p < 0.001), educational level (χ2 = 59.038, p < 0.001), monthly income (χ2 = 36.476, p < 0.001), health status (χ2 = 52.851, p < 0.001), and family physician vaccination recommendation (χ2 = 1251.479, p < 0.001) significantly impacted pneumococcal vaccination. For details, see Table 2.

3.2. Analysis of Marginal Effects of Family Physicians’ Recommendations

The AME value for family physicians giving influenza vaccination recommendations was 0.263, suggesting that physicians’ vaccine recommendations were able to boost influenza vaccination rates by 26.3% (95% CI = 0.249–0.277). Through 200 random samples of 50% of the data, the AME value was found to be stably distributed within the range of 0.250 to 0.275, indicating that the results are insensitive to data disturbances and exhibit good robustness.
The AME value for physicians giving pneumococcal vaccination recommendation was 0.237, suggesting that physicians’ pneumococcal vaccination recommendation was able to boost vaccination rates by 23.7% (95% CI = 0.225–0.248). Through 200 random samples of 50% of the data, the AME value was found to be stably distributed within the range of 0.227 to 0.250, indicating that the results are insensitive to data disturbances and exhibit good robustness.

3.3. Vaccine Policy Differences in the Probability of Influenza Vaccine and Pneumococcal Vaccine with Family Physician’s Recommendation and No Family Physician’s Recommendation

Table 3 provides unadjusted and adjusted rates of influenza and pneumococcal vaccine by vaccination price. For the influenza vaccine, among participants without a family physician recommendation, the adjusted probability for free vaccination (21.53%) was 1.64% (95% CI = 0.002–0.031) higher than for self-paid vaccination (19.89%). Among those with family physician recommendation, the adjusted probability for free vaccination (49.86%) was 2.50% (95% CI = 0.027–0.047) higher than for self-paid vaccination (47.36%). For the effect of family physician recommendation by vaccine price, the adjusted probability of vaccination with family physician recommendation was 27.47% (95% CI = 0.259–0.290) and 28.33% (95% CI = 0.265–0.301) higher, respectively, than the probability of vaccination without a recommendation for the self-paid and free vaccine groups. For pneumococcal vaccine, the effect of vaccine price by family physician recommendation was non-significant in all analyses. However, regarding the effect of family physician recommendation by vaccine price, the adjusted probability for self-paid vaccination was 28.78% (95% CI = 0.266–0.304) and for free vaccination was 28.91% (95% CI = 0.267–0.305) higher with family physician recommendation than without.

3.4. Age-Group Differences in the Probability of Influenza Vaccine and Pneumococcal Vaccine with Family Physician Recommendation and No Family Physician Recommendation

Table 4 provides unadjusted and adjusted rates of influenza and pneumococcal vaccination by age group. For influenza vaccination, the effect of age by family physician recommendation was non-significant in all analyses. However, older individuals with a physician’s recommendation had a higher probability of receiving both the influenza and pneumococcal vaccines compared to those without a physician’s recommendation, and this difference was significant in all analyses. Individuals aged 70–79 had the highest probability of vaccination in all analyses for both influenza and pneumococcal vaccines. For instance, in pneumococcal vaccination among those without a physician’s recommendation, the probability for individuals aged 70–79 was 15.41%, higher than for those aged 60–69 (14.12%) and those aged ≥80 (13.93%).

3.5. Gender Differences in the Probability of Influenza Vaccine and Pneumococcal Vaccine with Family Physician Recommendation and No Family Physician Recommendation

Table 5 provides unadjusted and adjusted rates of influenza and pneumococcal vaccination by gender. The result shows that participants with a family physician’s recommendation had a higher probability of vaccination than those without a recommendation for both influenza and pneumococcal vaccines, with significant differences in all analyses. For instance, in influenza vaccine, among males, the effect of a family physician recommendation on vaccination probability was 27.39% (95% CI = 0.262, 0.296).

3.6. Monthly Income Differences in the Probability of Influenza Vaccine and Pneumococcal Vaccine with Family Physician Recommendation and No Family Physician Recommendation

Table 6 provides unadjusted and adjusted rates of influenza and pneumococcal vaccination by monthly income. The result shows that older persons with high monthly incomes had a higher probability of receiving both the influenza and pneumococcal vaccines compared to those with lower monthly incomes, and these differences were significant in all analyses. For instance, for the influenza vaccine, among those without a physician’s recommendation, the adjusted probability for individuals with a monthly income of CNY 2500–5000 (21.37%) was 5.54% (95% CI = 0.041–0.070) higher than for those with a monthly income below CNY 2500 (15.83%). In addition, participants with a family physician’s recommendation had a higher probability of vaccination than those without a recommendation for both the influenza and pneumococcal vaccines, with significant differences in all analyses. For instance, for the pneumococcal vaccine, among individuals with a monthly income of CNY 5000–7500, the effect of a family physician’s recommendation on vaccination probability was 30.46% (95% CI = 0.282–0.326).

4. Discussion

This study discusses the impact of vaccination recommendations given by family physicians on influenza and pneumococcal vaccination rates among older adults in China. We found that only 48.78% and 28.56% of older adults had been recommended by their family physician to receive the influenza and pneumococcal vaccines, respectively—an overall low level. However, family physician recommendations had a significant impact on older adults’ vaccination behaviors. Current research on family physician recommendations for influenza and pneumonia vaccination in older adults is almost non-existent. This study has implications for improving influenza and pneumococcal vaccination coverage among the elderly and helps fill a gap in existing research.
Older adults are a key target population for influenza and pneumococcal vaccines, as noted by many vaccination guidelines and studies [32,33,34,35]. The survey shows that the influenza and pneumococcal vaccination rates among older adults were 34.05% and 22.79%, respectively—significantly higher than the national rates reported in 2023 [36]. Possible reasons for this include the increased dissemination of vaccine knowledge and updated vaccination policies. Additionally, the cities in our current survey may have higher levels of economic development than the national average, and rural older adults were not included. Nonetheless, these findings reflect an upward trend in vaccination rates among older adults.
As for the factors of influence, city, educational level, monthly income, health status, and family physician vaccination recommendation all showed significant effects on both influenza and pneumococcal vaccination rates. Previous studies have demonstrated that various factors affect vaccine uptake in older adults, and family physician recommendation is one of the most significant [17,37]. Family physicians’ recommendations play an import role in encouraging vaccination, which can contribute substantially to vaccination uptake [38,39]. In our study, family physician recommendation increased influenza vaccination by 26.3% and pneumococcal vaccination by 23.7%, both with a significant impact. Other studies also suggest that the advice of medical staff such as doctors, physicians and nurses has a strong influence on older adults [40,41]. Trust in physicians makes elderly individuals more likely to follow vaccination recommendations.
We also explored the role of family physician recommendations in subgroups with different characteristics. Some regions in China currently offer free influenza or pneumococcal vaccines, such as Beijing and Shenzhen [42,43]. Our study showed that the free vaccine policy was not statistically significant in predicting overall vaccination rates. However stratified analyses revealed that the policy had a positive effect on both influenza and pneumococcal vaccination among the elderly. While other studies suggest that vaccine price is a factor influencing uptake and that lower prices have a positive effect [44], our findings show that although free vaccination policies provide a small boost, they do not yield statistically significant results in one-way analyses—consistent with past research [45].
In contrast, family physician recommendations produced a much larger effect, highlighting that recommendation behaviors may be more influential than cost. Moreover, vaccination rates were higher when vaccines were both free and recommended by a family physician. This suggests that combining free vaccine policies with increased referrals from medical personnel can more effectively raise vaccination rates among older adults.
Economic level also played a role in influencing vaccination. Our study found that older adults with higher monthly incomes had higher rates of influenza and pneumococcal vaccination, especially those in the CNY 5000–7500 income range [46]. These higher rates in wealthier groups may be linked to greater health awareness, better access to information, or higher willingness to pay.
We also found that family physician recommendations had the greatest boosting effect on vaccination among individuals aged 70–79. These findings highlight the importance of age-specific communication strategies. For example, family physicians may need to take a more proactive and educational approach with the 60–69 age group, emphasizing early protection even if they feel healthy. For the 70–79 age group, leveraging routine visits and reinforcing trust relationships may further increase vaccination uptake. And gender was not an especially impactful factor.
We recommend strengthening the role of medical personnel in promoting influenza and pneumococcal vaccination among older adults. It is worth noting that the implementation of the family physician policy by the Chinese government can improve access to health services and provide older adults with more opportunities to interact with healthcare workers [47]. Family physicians can enhance older adults’ knowledge about influenza and pneumococcal vaccines and encourage positive vaccination behaviors [45]. One study found that how family physicians recommend vaccines also influences the vaccination decisions of older adults [48,49].
Healthcare professionals should adopt different vaccine recommendation strategies based on the characteristics of older adults. For seniors, proactively acquiring vaccine knowledge is a vital health-promoting behavior. Therefore, health education should be further leveraged to promote initiative and awareness about vaccination among the elderly.
This study has some limitations. First, as a cross-sectional study, it cannot infer causality. Second, the study population included only older adults in urban areas and excluded those in rural regions, which may be affected by differences in economic level, education, and access to care. Thirdly, vaccination status was self-reported, and although the survey was conducted face-to-face, there is still potential for information bias. Furthermore, in future research, we could pay attention to detailed information about elderly individuals and family physicians, such as the experience of family physicians. Despite these limitations, this study fills a gap in understanding the role of healthcare workers in promoting vaccination.

5. Conclusions

This study analyzed the effect of general family physician recommendations on influenza and pneumococcal vaccination rates among urban Chinese older adults. The results showed that family physician recommendations had a significant effect and that individuals with different demographic characteristics had varying sensitivities to those recommendations. In the future, the role of medical staff in recommending vaccinations should be strengthened, and older adults’ motivation and awareness of necessary vaccination knowledge should be improved.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/vaccines13080886/s1, File S1: Questionnaire Structure and Content.

Author Contributions

Data curation, Y.W.; formal analysis, Y.W. and J.D.; investigation, Y.W., J.D., S.Y., Y.C., G.L., Q.Q., C.L. and R.D.; methodology, Y.W., Y.C., Z.Z., L.Z., Q.Z. and L.Y.; writing—original draft, Y.W. and J.D. All writers affirm they satisfy the ICMJE criteria for authorship and made significant contributions to the conception and design, participated in writing the article or revising it critically for significant intellectual content, and gave final approval to its submission. All authors have read and agreed to the published version of the manuscript.

Funding

This study was funded by the Beijing Natural Science Foundation-Haidian Original Innovation Joint Fund Project [grant number L242146].

Institutional Review Board Statement

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and obtained ethical approval from the Institutional Review Board of the Chinese Academy of Medical Sciences & Peking Union Medical College, which oversees research involving human subjects on 21 January 2025 (CAMS&PUMC-IEC-2025-002).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data within this article will be shared upon reasonable request to the corresponding author.

Acknowledgments

We are deeply appreciative of all the participants from Beijing, Shenzhen, Hangzhou, Qingdao, Chongqing, and Chengdu for their invaluable time and insights. We also extend our heartfelt gratitude to our postgraduate research assistants at Peking Union Medical College for their unwavering cooperation and assistance. Finally, special thanks go to Yuanruo Xie for her invaluable assistance in refining the language of this article.

Conflicts of Interest

The authors have no conflicts of interest relevant to this article to disclose.

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Figure 1. Distribution of sampled participants.
Figure 1. Distribution of sampled participants.
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Figure 2. Recruitment process of sampled participants.
Figure 2. Recruitment process of sampled participants.
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Table 1. Demographic characteristics of participants.
Table 1. Demographic characteristics of participants.
Demographic CharacteristicsN%
CityBeijing218016.31
Chengdu205915.41
Hangzhou220816.52
Qingdao214016.01
Shenzhen225316.86
Chongqing252318.88
GenderMale604845.26
Female731554.74
Age60–69767857.46
70–79430232.19
≥80138310.35
EthnicityHan13,07397.83
Minorities2902.17
Education LevelPrimary School and Below372027.84
Junior High School399229.87
Senior High School346125.90
Bachelor’s Degree205015.34
Postgraduate1401.05
Monthly Income (CNY *)≤2500385028.81
2501–5000582943.62
5001–7500245718.39
>750012279.18
Health StatusVery Poor2151.61
Poor11888.89
Fair536740.16
Good542140.57
Very Good11728.77
Vaccine Price (Influenza Vaccination)Self-pay881365.95
Free455034.05
Vaccine Price (Pneumococcal Vaccination)Self-pay10,31777.21
Free304622.79
Vaccine Uptake (Influenza Vaccination)No881365.95
Yes455034.05
Vaccine Uptake (Pneumococcal Vaccination)No10,31777.21
Yes304622.79
Family Physician Vaccination Recommendation (Influenza Vaccination)No684551.22
Yes651848.78
Family Physician Vaccination Recommendation (Pneumococcal Vaccination)No954671.44
Yes381728.56
* CNY: Chinese yuan; US dollars (USD) have an average exchange rate of CNY 7.19 per USD in December 2024 [31].
Table 2. Factors associated with influenza and pneumococcal vaccination—results of bivariate analyses.
Table 2. Factors associated with influenza and pneumococcal vaccination—results of bivariate analyses.
VariableInfluenza VaccinePneumococcal Vaccine
Non-VaccinatedVaccinatedp-Valueχ2Non-VaccinatedVaccinatedp-Valueχ2
N (%)N (%)N (%)N (%)
CityBeijing1472 (67.52%)708 (32.48%)<0.001187.6841659 (76.10%)521 (23.90%)<0.001271.66
Chengdu1414 (68.67%)645 (31.33%) 1367 (66.39%)692 (33.61%)
Hangzhou1195 (54.12%)1013 (45.88%) 1655 (74.95%)553 (25.05%)
Qingdao1540 (71.96%)600 (28.04%) 1637 (76.50%)503 (23.50%)
Shenzhen1470 (65.25%)783 (34.75%) 1934 (85.84%)319 (14.16%)
Chongqing1722 (68.25%)801 (31.75%) 2065 (81.85%)458 (18.15%)
GenderMale3938 (65.11%)2110 (34.89%)0.0633.4584635 (76.64%)1413 (23.36%)0.1542.031
Female4875 (66.64%)2440 (33.36%) 5682 (77.68%)1633 (22.32%)
Age 60–695038 (65.62%)2640 (34.38%)1.3830.5015929 (77.22%)1749 (22.78%)0.3182.289
70–792846 (66.16%)1456 (33.84%) 3300 (76.71%)1002 (23.29%)
≥80929 (67.17%)454 (32.83%) 1088 (78.67%)295 (21.33%)
EthnicityHan Chinese8628 (66.00%)4445 (34.00%)0.4330.00710,100 (77.26%)2973 (22.74%)0.3290.953
Minorities185 (63.79%)105 (36.21%) 217 (74.83%)73 (25.17%)
Education LevelPrimary School and Below2677 (71.96%)1043 (28.04%)<0.00199.6952972 (79.89%)748 (20.11%)<0.00159.038
Junior High School2609 (65.36%)1383 (34.64%) 3100 (77.66%)892 (22.34%)
Senior High School2205 (63.71%)1256 (36.29%) 2680 (77.43%)781 (22.57%)
Bachelor’s Degree1243 (60.63%)807 (39.37%) 1472 (71.80%)578 (28.20%)
Postgraduate79 (56.43%)61 (43.57%) 93 (66.43%)47 (33.57%)
Monthly Income (CNY)≤25002849 (74.00%)1001 (26.00%)<0.001157.1523095 (80.39%)755 (19.61%)<0.00136.476
2501—50003676 (63.06%)2153 (36.94%) 4458 (76.48%)1371 (23.52%)
5001—75001520 (61.86%)937 (38.14%) 1824 (74.24%)633 (25.76%)
≥7500768 (62.59%)459 (37.41%) 940 (76.61%)287 (23.39%)
Health StatusVery Poor125 (58.14%)90 (41.86%)0.00415.594132 (61.40%)83 (38.60%)<0.00152.851
Poor813 (68.43%)375 (31.57%) 954 (80.30%)234 (19.70%)
Fair3599 (67.06%)1768 (32.94%) 4214 (78.52%)1153 (21.48%)
Good3519 (64.91%)1902 (35.09%) 4157 (76.68%)1264 (23.32%)
Very Good757 (64.59%)415 (35.41%) 860 (73.38%)312 (26.62%)
Family Physician Vaccination RecommendationNo5405 (78.96%)1440 (21.04%)<0.0011058.0918145 (85.32%)1401 (14.68%)<0.0011251.479
Yes3408 (52.29%)3110 (47.71%) 2172 (56.90%)1645 (43.10%)
Vaccine PriceSelf-pay5871 (66.62%)2942 (33.38%)0.4760.5094279 (41.48%)6038 (58.52%)0.4450.584
Free3059 (67.23%)1491 (32.77%) 1287 (42.25%)1759 (57.75%)
Table 3. Vaccine policy differences in the probability of influenza vaccine and pneumococcal vaccine with family physician recommendation and no family physician recommendation.
Table 3. Vaccine policy differences in the probability of influenza vaccine and pneumococcal vaccine with family physician recommendation and no family physician recommendation.
Family Physician RecommendationVaccine Price Influenza VaccinePneumococcal Vaccine
UnadjustedAdjustedUnadjustedAdjusted
Vaccinated (%)p-ValueVaccinated (%) aEffect of Vaccine Price by Family Physician Recommendation (pp) b95% CIEffect of Physician Family Recommendation by Vaccine Price (pp) c95% CIVaccinated (%)p-ValueVaccinated (%) aEffect of Vaccine Price by Family Physician Recommendation (pp) b95% CIEffect of Family Physician Recommendation by Vaccine Price (pp) c95% CI
NoSelf-pay18.50%<0.00119.89%reference reference 14.90%0.62214.38%reference reference
Free24.40%21.53%1.64%(0.002,0.031) *reference 14.50%14.53%0.15%(−0.010, 0.011)reference
YesSelf-pay46.50%<0.00147.36%reference 27.47%(0.259, 0.290) *41.60%0.10343.16%reference 28.78%(0.266, 0.304) *
Free51.70%49.86%2.50%(0.003,0.047) *28.33%(0.265, 0.301) *44.30%43.44%0.28%(−0.019, 0.023)28.91%(0.267, 0.305) *
* p < 0.05. a Estimates are from a multivariable logistic regression model adjusted for gender, ethnicity, age, educational level, monthly income, health status. b Effect of vaccine price by recommendation (pp) represents differences in the probability of vaccination by vaccine price. For instance, among those with no family physician vaccination recommendation, the adjusted influenza vaccine uptake probability of self-paid vaccines was 19.89% and of free vaccines was 21.53%, so the effect of free vaccination in those with no family physician vaccination recommendation was 21.53% − 19.89% = 1.64%. c The effect of recommendation by vaccine price (pp) represents differences in the probability of vaccination by family physician recommendation. For instance, among self-paid vaccines, uptake with family physician recommendation’s probability was 47.36%; with no family physician recommendation, influenza vaccine probability was 18.50%; the effect of family physician recommendation in self-paid vaccines was 47.36% − 19.89% = 27.47%.
Table 4. Age-group differences in the probability of influenza vaccine and pneumococcal vaccine with family physician recommendation and no family physician recommendation.
Table 4. Age-group differences in the probability of influenza vaccine and pneumococcal vaccine with family physician recommendation and no family physician recommendation.
Family Physician RecommendationAgeInfluenza VaccinePneumococcal Vaccine
UnadjustedAdjustedUnadjustedAdjusted
Vaccinated (%)p-ValueVaccinated (%) aEffect of Age by Family Physician Recommendation (pp) b95% CIEffect of Family Physician Recommendation by Age (pp) c95% CIVaccinated (%)p-ValueVaccinated (%) aEffect of Age by Family Physician Recommendation (pp) b95% CIEffect of Family Physician Recommendation by Age (pp) c95% CI
No60–6919.70%0.00421.37%reference reference 14.20%0.02514.12%reference reference
70–7923.30%22.28%0.91%(−0.005,0.024)reference 16.00%15.41%1.29%(0.001,0.025) *reference
≥8020.90%20.47%−0.90%(−0.030,0.013)reference 13.10%13.93%−0.19%(−0.020,0.016)reference
Yes60–6949.30%0.00449.48%reference 28.11%(0.267, 0.300) *43.60%0.64342.68%reference 28.56%(0.267, 0.304) *
70–7946.30%50.81%1.33%(−0.008,0.034)28.53%(0.270, 0.305) *42.70%45.21%2.53%(0.002,0.049) *29.80%(0.277, 0.317) *
≥8043.30%48.12%−1.36%(−0.046,0.019)27.65%(0.260, 0.298) *41.30%42.30%−0.38%(0.033,0.838) *28.37%(0.277, 0.317) *
* p < 0.05. a Estimates are from a multivariable logistic regression model adjusted for gender, ethnicity, monthly income, educational level, health status, vaccine price. b Effect of age by recommendation (pp) represents differences in the probability of vaccination by age. For instance, among those with no family physician vaccination recommendation, the adjusted influenza vaccine uptake probability of 70–79-year-olds was 22.28%; the probability of 60–69% was 21.37%, so the effect of age (70–79 years old) on influenza vaccine uptake in those with no family physician vaccination recommendation was 22.28% − 21.37% = 0.91%. c The effect of recommendation by age (pp) represents differences in the probability of vaccination by family physician recommendation. For instance, among 60–69-year-olds with family physician recommendation, influenza vaccine probability was 49.48%, while the probability for those with no family physician recommendation was 21.37%; the effect of family physician recommendation in 60–69-year-olds was 49.48% − 21.37% = 28.11%.
Table 5. Gender differences in the probability of influenza vaccine and pneumococcal vaccine with family physician recommendation and no family physician recommendation.
Table 5. Gender differences in the probability of influenza vaccine and pneumococcal vaccine with family physician recommendation and no family physician recommendation.
Family Physician RecommendationGenderInfluenza VaccinePneumococcal Vaccine
UnadjustedAdjustedUnadjustedAdjusted
Vaccinated (%)p-ValueVaccinated (%) aEffect of Gender by Family Physician Recommendation (pp) b95% CIEffect of Family Physician Recommendation by Gender (pp) c95% CIVaccinated (%)p-ValueVaccinated (%) aEffect of Gender by Family Physician Recommendation (pp) b95% CIEffect of Family Physician Recommendation by Gender (pp) c95% CI
NoMale20.30%0.18819.72%reference reference 14.50%0.65114.48%reference reference
Female21.60%20.02%0.30%(−0.009, 0.015)reference 14.80%14.56%0.08%(−0.010, 0.012)reference
YesMale49.10%0.02947.11%reference 27.39%(0.262, 0.296) *44.40%0.11443.36%reference 28.88%(0.270, 0.306) *
Female46.40%47.57%0.46%(−0.014, 0.024)27.55%(0.264, 0.298) *41.90%43.51%0.15%(−0.020, 0.023)28.95%(0.271, 0.307) *
* p < 0.05. a Estimates are from a multivariable logistic regression model adjusted for ethnicity, age, educational level, health status, vaccine price. b Effect of gender by recommendation (pp) represents differences in the probability of vaccination by monthly income. For instance, among those with no family physician vaccination recommendation, the adjusted influenza vaccine uptake probability of males was 19.72% and the probability of females was 20.02%, so the effect of gender in those no family physician vaccination recommendation was 20.02% − 19.72% = 0.30%. c The effect of recommendation by gender (pp) represents differences in the probability of vaccination by family physician recommendation. For instance, among males with family physician recommendations, influenza vaccine probability was 47.11%, while males with no family physician recommendation had a probability of 19,72%; the effect of family physician recommendation in males was 47.11% − 19.72% = 27.39%.
Table 6. Monthly income differences in the probability of influenza vaccine and pneumococcal vaccine with family physician recommendation and no family physician recommendation.
Table 6. Monthly income differences in the probability of influenza vaccine and pneumococcal vaccine with family physician recommendation and no family physician recommendation.
Family Physician RecommendationMonthly Income (CNY)Influenza VaccinePneumococcal Vaccine
UnadjustedAdjusted UnadjustedAdjusted
Vaccinated (%)p-ValueVaccinated (%) aEffect of Monthly Income by Family Physician Recommendation (pp) b95% CIEffect of Family Physician Recommendation by Monthly Income (pp) c95% CIVaccinated (%)p-ValueVaccinated (%) aEffect of Monthly Income by Family Physician Recommendation (pp) b95% CIEffect of Family Physician Recommendation by Monthly Income (pp) c95% CI
No<250013.70%<0.00115.83%reference reference 13.23%<0.00112.25%reference reference
2500–500022.10%21.37%5.54%(0.041, 0.070) *reference 14.06%14.41%2.16%(0.010,0.034) *reference
5000–750025.70%22.36%6.53%(0.044, 0.087) *reference 16.09%18.08%5.83%(0.042,0.075) *reference
>750029.30%20.16%4.33%(0.016, 0.070) *reference 13.28%16.23%3.98%(0.019,0.061) *reference
Yes<250040.00%<0.00140.39%reference 24.56%(0.232, 0.266) *40.92%<0.00138.54%reference 27.69%(0.256, 0.297) *
2500–500050.10%49.48%9.09%(0.067, 0.115) *28.11%(0.267, 0.300) *42.62%43.06%4.52%(0.020,0.070) *28.56%(0.267, 0.304) *
5000–750054.00%50.92%10.53%(0.072, 0.139) *28.56%(0.270, 0.306) *46.55%49.79%11.25%(0.082,0.144) *30.46%(0.282, 0.326) *
>750047.20%47.63%7.24%(0.029, 0.116) *27.47%(0.258, 0.297) *41.01%46.53%7.99%(0.040,0.120) *27.73%(0.250, 0.304) *
* p < 0.05. a Estimates are from a multivariable logistic regression model adjusted for gender, ethnicity, age, educational level, health status, vaccine price. b Effect of monthly income by recommendation (pp) represents differences in the probability of vaccination by monthly income. For instance, among those with no family physician vaccination recommendation, the adjusted influenza vaccine uptake probability of CNY <2500 was 15.83% and the probability of CNY 2500–5000 was 21.37%, so the effect of monthly income (CNY 2500–5000) in those with no family physician vaccination recommendation was 21.37% − 15.83% = 5.54%. c The effect of recommendation by monthly income (pp) represents differences in the probability of vaccination by physician recommendation. For instance, among those whose monthly income was CNY 2500–5000, those with family physician recommendations had an influenza vaccine probability of 49.48%, while those with no family physician recommendation had a probability of 21.37%; the effect of family physician recommendation in those with CNY 2500–5000 monthly income was 49.48% − 21.37% = 28.11%.
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Wang, Y.; Dai, J.; Yuan, S.; Chen, Y.; Zhang, Z.; Zhu, L.; Liu, G.; Zeng, Q.; Qiu, Q.; Luo, C.; et al. Do Family Physicians’ Recommendations for Influenza and Pneumococcal Vaccines Impact the Elderly Aged ≥60 Years? A Cross-Sectional Study in Six Chinese Cities. Vaccines 2025, 13, 886. https://doi.org/10.3390/vaccines13080886

AMA Style

Wang Y, Dai J, Yuan S, Chen Y, Zhang Z, Zhu L, Liu G, Zeng Q, Qiu Q, Luo C, et al. Do Family Physicians’ Recommendations for Influenza and Pneumococcal Vaccines Impact the Elderly Aged ≥60 Years? A Cross-Sectional Study in Six Chinese Cities. Vaccines. 2025; 13(8):886. https://doi.org/10.3390/vaccines13080886

Chicago/Turabian Style

Wang, Yuxing, Jianing Dai, Shuai Yuan, Ying Chen, Zhujiazi Zhang, Ling Zhu, Gang Liu, Qiang Zeng, Qian Qiu, Chunyu Luo, and et al. 2025. "Do Family Physicians’ Recommendations for Influenza and Pneumococcal Vaccines Impact the Elderly Aged ≥60 Years? A Cross-Sectional Study in Six Chinese Cities" Vaccines 13, no. 8: 886. https://doi.org/10.3390/vaccines13080886

APA Style

Wang, Y., Dai, J., Yuan, S., Chen, Y., Zhang, Z., Zhu, L., Liu, G., Zeng, Q., Qiu, Q., Luo, C., Deng, R., & You, L. (2025). Do Family Physicians’ Recommendations for Influenza and Pneumococcal Vaccines Impact the Elderly Aged ≥60 Years? A Cross-Sectional Study in Six Chinese Cities. Vaccines, 13(8), 886. https://doi.org/10.3390/vaccines13080886

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