Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Elderly Individuals with and without Disabilities: A Nationwide, Population-Based Cohort Study
Abstract
:1. Introduction
2. Methods
2.1. Data Source
2.2. Outcome Measures
2.3. Measures of Predictors
2.4. Statistical Analysis
2.5. Ethics Approval and Consent
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
References
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Variables | Total (N = 2,741,403) | Elderly Individuals without Disability (N = 2,346,913) | Elderly Individuals with Disability (N = 394,490) | |||||
---|---|---|---|---|---|---|---|---|
n | % | Without IV | With IV | p-Value 1 | Without IV | With IV | p-Value 1 | |
% | % | % | % | |||||
Total | 2,741,403 | 100.00 | 1,624,596 (69.22%) | 722,317 (30.78%) | 258,042 (65.41%) | 136,448 (34.59%) | ||
Gender | <0.001 | <0.001 | ||||||
Female | 1,469,819 | 53.62 | 69.75 | 30.25 | 66.18 | 33.82 | ||
Male | 1,271,584 | 46.38 | 68.60 | 31.40 | 64.64 | 35.36 | ||
Age (year) (mean ± SD) | 74.53 ± 7.33 | 73.51 ± 7.16 | 75.39 ± 6.95 | <0.001 | 76.76 ± 8.01 | 77.90 ± 7.56 | <0.001 | |
65–69 | 840,533 | 30.66 | 77.77 | 22.23 | 72.91 | 27.09 | ||
70–74 | 683,448 | 24.93 | 69.33 | 30.67 | 66.99 | 33.01 | ||
75–79 | 529,462 | 19.31 | 62.59 | 37.41 | 62.55 | 37.45 | ||
≧80 | 687,960 | 25.10 | 62.54 | 37.46 | 62.12 | 37.88 | ||
Premium salary (NTD) | <0.001 | <0.001 | ||||||
19,273 | 884,340 | 32.26 | 71.19 | 28.81 | 65.70 | 34.30 | ||
19,274-22,800 | 1,098,738 | 40.08 | 65.17 | 34.83 | 63.29 | 36.71 | ||
22,801-45,800 | 461,607 | 16.84 | 73.31 | 26.69 | 68.89 | 31.11 | ||
≧45,801 | 296,718 | 10.82 | 71.87 | 28.13 | 67.76 | 32.24 | ||
Urbanization | <0.001 | <0.001 | ||||||
Urban | 1,453,747 | 53.03 | 73.12 | 26.88 | 68.46 | 31.54 | ||
Suburban | 893,278 | 32.58 | 65.94 | 34.06 | 63.43 | 36.57 | ||
Rural | 394,378 | 14.39 | 61.80 | 38.20 | 60.75 | 39.25 | ||
CCI score | <0.001 | <0.001 | ||||||
0 | 2,170,934 | 79.19 | 70.67 | 29.33 | 67.43 | 32.57 | ||
1 or 2 | 368,417 | 13.44 | 62.69 | 37.31 | 61.86 | 38.14 | ||
3 or 4 | 147,741 | 5.39 | 62.33 | 37.67 | 61.41 | 38.59 | ||
≧5 | 54,311 | 1.98 | 64.54 | 35.46 | 62.64 | 37.36 | ||
Catastrophic illnesses | <0.001 | <0.001 | ||||||
No | 2,480,370 | 90.48 | 69.37 | 30.63 | 65.70 | 34.30 | ||
Yes | 261,033 | 9.52 | 67.45 | 32.55 | 64.35 | 35.65 | ||
Long-term care facility resident | <0.001 | <0.001 | ||||||
No | 2,713,653 | 98.99 | 69.32 | 30.68 | 66.73 | 33.27 | ||
Yes | 27,750 | 1.01 | 43.10 | 56.90 | 39.73 | 60.27 | ||
Utilization of outpatient care 2 | <0.001 | <0.001 | ||||||
<18 | 1,370,072 | 49.98 | 76.41 | 23.59 | 75.28 | 24.72 | ||
≧18 | 1,371,331 | 50.02 | 61.39 | 38.61 | 59.62 | 40.38 | ||
Hospital admission 2 | <0.001 | <0.001 | ||||||
No | 2,357,683 | 86.00 | 69.51 | 30.49 | 65.83 | 34.17 | ||
Yes | 383,720 | 14.00 | 67.12 | 32.88 | 64.16 | 35.84 | ||
Utilization of health examination services 2 | <0.001 | <0.001 | ||||||
No | 1,969,323 | 71.84 | 73.88 | 26.12 | 69.85 | 30.15 | ||
Yes | 772,080 | 28.16 | 57.85 | 42.15 | 50.45 | 49.55 |
Variables | Elderly Individuals with All Disability (N = 394,490) | Elderly Individuals with Physical Disability 1 (N = 346,176) | Elderly Individuals with Mental Disability 2 (N = 48,314) | |||||
---|---|---|---|---|---|---|---|---|
n | % | Without IV | With IV | p-Value 3 | Without IV | With IV | p-Value 3 | |
% | % | % | % | |||||
Total | 394,490 | 100.00 | 227,157 (65.62%) | 119,019 (34.38%) | 30,885 (63.93%) | 17,429 (36.07%) | ||
Gender | <0.001 | <0.001 | ||||||
Female | 198,020 | 50.20 | 66.46 | 33.54 | 64.62 | 35.38 | ||
Male | 196,470 | 49.80 | 64.83 | 35.17 | 62.72 | 37.28 | ||
Age (year) (mean ± SD) | 77.15 ± 7.88 | 76.60 ± 7.92 | 77.73 ± 7.46 | <0.001 | 77.92 ± 8.60 | 79.00 ± 8.16 | <0.001 | |
65–69 | 80,224 | 20.34 | 73.15 | 26.85 | 71.17 | 28.83 | ||
70–74 | 81,779 | 20.73 | 67.24 | 32.76 | 64.69 | 35.31 | ||
75–79 | 80,924 | 20.51 | 62.61 | 37.39 | 61.99 | 38.01 | ||
≧80 | 151,563 | 38.42 | 62.27 | 37.73 | 61.27 | 38.73 | ||
Premium salary (NTD) | <0.001 | <0.001 | ||||||
19,273 | 133,071 | 33.73 | 66.12 | 33.88 | 63.52 | 36.48 | ||
19,274-22,800 | 161,451 | 40.93 | 63.31 | 36.69 | 63.07 | 36.93 | ||
22,801-45,800 | 61,481 | 15.58 | 69.22 | 30.78 | 66.21 | 33.79 | ||
≧45,801 | 38,487 | 9.76 | 68.12 | 31.88 | 65.19 | 34.81 | ||
Urbanization | <0.001 | <0.001 | ||||||
Urban | 191,671 | 48.59 | 68.77 | 31.23 | 66.49 | 33.51 | ||
Suburban | 134,518 | 34.10 | 63.69 | 36.31 | 61.40 | 38.60 | ||
Rural | 68,301 | 17.31 | 60.85 | 39.15 | 59.86 | 40.14 | ||
CCI score | <0.001 | <0.001 | ||||||
0 | 252,010 | 63.88 | 67.65 | 32.35 | 66.09 | 33.91 | ||
1 or 2 | 81,150 | 20.57 | 62.36 | 37.64 | 57.66 | 42.34 | ||
3 or 4 | 41,112 | 10.42 | 61.75 | 38.25 | 57.37 | 42.63 | ||
≧5 | 20,218 | 5.13 | 62.66 | 37.34 | 62.14 | 37.86 | ||
Catastrophic illnesses | <0.001 | <0.001 | ||||||
No | 310,708 | 78.76 | 65.85 | 34.15 | 64.44 | 35.56 | ||
Yes | 83,782 | 21.24 | 64.69 | 35.31 | 62.88 | 37.12 | ||
Long-term care facility resident | <0.001 | <0.001 | ||||||
No | 375,171 | 95.10 | 66.80 | 33.20 | 66.25 | 33.75 | ||
Yes | 19,319 | 4.90 | 40.09 | 59.91 | 38.39 | 61.61 | ||
Utilization of outpatient care 4 | <0.001 | <0.001 | ||||||
<18 | 145,799 | 36.96 | 75.27 | 24.73 | 75.34 | 24.66 | ||
≧18 | 248,691 | 63.04 | 60.16 | 39.84 | 55.30 | 44.70 | ||
Hospital admission 4 | <0.001 | <0.001 | ||||||
No | 295,965 | 75.02 | 65.92 | 34.08 | 65.17 | 34.83 | ||
Yes | 98,525 | 24.98 | 64.71 | 35.29 | 60.38 | 39.62 | ||
Utilization of health examination services 4 | <0.001 | <0.001 | ||||||
No | 304,258 | 77.13 | 69.89 | 30.11 | 69.55 | 30.45 | ||
Yes | 90,232 | 22.87 | 51.38 | 48.62 | 43.34 | 56.66 |
Outcomes | Total (N = 2,741,403) | Without Disability/ without IV (ref.) (N = 1,624,596) | Without Disability/with IV(N = 722,317) | With Disability/without IV(N = 258,042) | With Disability/with IV(N = 136,448) | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Incident (‰) | Incident (‰) | Incident (‰) | RR 1 | 95% CI | Incident (‰) | RR 1 | 95% CI | Incident (‰) | RR 1 | 95% CI | |||||||
All-cause death | 34.06 | 27.10 | 22.05 | 0.64*** | 0.63 | - | 0.66 | 88.96 | 1.81*** | 1.78 | - | 1.84 | 76.59 | 1.18*** | 1.16 | - | 1.21 |
Hospitalization | |||||||||||||||||
Influenza or pneumonia | 38.00 | 26.59 | 30.45 | 0.88*** | 0.86 | - | 0.89 | 91.99 | 2.01*** | 1.97 | - | 2.04 | 111.84 | 1.85*** | 1.81 | - | 1.90 |
Respiratory diseases | 58.06 | 42.55 | 48.88 | 0.89*** | 0.87 | - | 0.90 | 131.09 | 1.89*** | 1.86 | - | 1.92 | 153.19 | 1.72*** | 1.69 | - | 1.75 |
COPD | 21.35 | 15.15 | 21.29 | 1.02 | 1.00 | - | 1.04 | 41.02 | 1.46*** | 1.42 | - | 1.49 | 58.33 | 1.56*** | 1.52 | - | 1.61 |
Respiratory failure | 15.76 | 11.04 | 11.42 | 0.81*** | 0.79 | - | 0.83 | 42.51 | 2.06*** | 2.01 | - | 2.12 | 44.32 | 1.63*** | 1.58 | - | 1.69 |
Heart disease | 44.33 | 35.82 | 41.79 | 0.95*** | 0.94 | - | 0.97 | 81.26 | 1.47*** | 1.45 | - | 1.50 | 89.17 | 1.39*** | 1.36 | - | 1.42 |
Hemorrhagic stroke | 2.23 | 1.99 | 1.81 | 0.82*** | 0.77 | - | 0.87 | 4.11 | 1.54*** | 1.44 | - | 1.66 | 3.65 | 1.30*** | 1.17 | - | 1.43 |
Ischemic stroke | 9.01 | 8.01 | 7.88 | 0.85*** | 0.83 | - | 0.88 | 15.61 | 1.50*** | 1.44 | - | 1.55 | 14.35 | 1.29*** | 1.23 | - | 1.36 |
Any of the above disease | 87.16 | 68.16 | 77.69 | 0.91*** | 0.90 | - | 0.92 | 174.77 | 1.73*** | 1.70 | - | 1.75 | 197.81 | 1.59*** | 1.56 | - | 1.62 |
Outcomes | Without Disability/without IV (ref.) | Without Disability/with IV | With Disability/without IV | With Disability/with IV | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean | Mean | Exp (b) | 95% CI | Mean | Exp (b) | 95% CI | Mean | Exp (b) | 95% CI | |||||||
Length of stay | ||||||||||||||||
Influenza or pneumonia | 19.36 | 19.01 | 0.95*** | 0.95 | - | 0.96 | 24.18 | 1.17*** | 1.17 | - | 1.18 | 22.61 | 1.05*** | 1.05 | - | 1.06 |
Respiratory diseases | 20.82 | 19.71 | 0.93*** | 0.93 | - | 0.94 | 27.40 | 1.23*** | 1.23 | - | 1.24 | 24.62 | 1.07*** | 1.07 | - | 1.08 |
COPD | 16.03 | 15.66 | 0.95*** | 0.95 | - | 0.96 | 23.25 | 1.33*** | 1.32 | - | 1.33 | 20.85 | 1.14*** | 1.13 | - | 1.15 |
Respiratory failure | 31.94 | 30.92 | 0.98*** | 0.97 | - | 0.98 | 38.65 | 1.20*** | 1.20 | - | 1.21 | 33.04 | 1.04*** | 1.03 | - | 1.04 |
Heart disease | 13.12 | 11.95 | 0.91*** | 0.91 | - | 0.91 | 17.09 | 1.22*** | 1.21 | - | 1.22 | 15.39 | 1.08*** | 1.07 | - | 1.09 |
Hemorrhagic stroke | 25.32 | 25.09 | 0.93*** | 0.92 | - | 0.94 | 25.65 | 1.04*** | 1.02 | - | 1.05 | 21.19 | 0.89*** | 0.87 | - | 0.91 |
Ischemic stroke | 17.97 | 16.02 | 0.91*** | 0.90 | - | 0.92 | 18.98 | 1.06*** | 1.05 | - | 1.07 | 16.55 | 0.94*** | 0.93 | - | 0.96 |
Any of the above disease | 39.04 | 37.32 | 0.92*** | 0.92 | - | 0.92 | 58.38 | 1.33*** | 1.33 | - | 1.34 | 53.93 | 1.15*** | 1.15 | - | 1.15 |
Medical expenditure | ||||||||||||||||
Influenza or pneumonia | 127,283 | 118,958 | 0.93*** | 0.91 | - | 0.95 | 152,579 | 1.13*** | 1.11 | - | 1.15 | 133,165 | 0.98* | 0.96 | - | 1.00 |
Respiratory diseases | 144,588 | 131,018 | 0.92*** | 0.91 | - | 0.93 | 173,649 | 1.14*** | 1.13 | - | 1.16 | 148,062 | 0.98 * | 0.96 | - | 1.00 |
COPD | 90,824 | 86,951 | 0.95*** | 0.93 | - | 0.97 | 119,238 | 1.21*** | 1.18 | - | 1.24 | 105,366 | 1.06 *** | 1.03 | - | 1.09 |
Respiratory failure | 273,615 | 259,611 | 0.98 | 0.95 | - | 1.01 | 285,946 | 1.06*** | 1.03 | - | 1.08 | 243,127 | 0.94*** | 0.91 | - | 0.97 |
Heart disease | 116,230 | 106,596 | 0.94*** | 0.93 | - | 0.96 | 131,848 | 1.10*** | 1.08 | - | 1.12 | 116,959 | 1.00 | 0.98 | - | 1.03 |
Hemorrhagic stroke | 207,191 | 208,435 | 0.93*** | 0.92 | - | 0.94 | 201,859 | 0.99 | 0.92 | - | 1.07 | 156,093 | 0.82*** | 0.74 | - | 0.92 |
Ischemic stroke | 104,378 | 98,026 | 0.95** | 0.92 | - | 0.98 | 115,741 | 1.09*** | 1.05 | - | 1.13 | 101,478 | 0.97 | 0.92 | - | 1.02 |
Any of the above disease | 283,865 | 263,189 | 0.91*** | 0.90 | - | 0.93 | 384,479 | 1.25*** | 1.23 | - | 1.26 | 338,457 | 1.06*** | 1.04 | - | 1.08 |
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Chang, Y.-C.; Tung, H.-J.; Huang, Y.-T.; Lu, C.-T.; Ernawaty, E.; Wu, S.-Y. Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Elderly Individuals with and without Disabilities: A Nationwide, Population-Based Cohort Study. Vaccines 2020, 8, 112. https://doi.org/10.3390/vaccines8010112
Chang Y-C, Tung H-J, Huang Y-T, Lu C-T, Ernawaty E, Wu S-Y. Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Elderly Individuals with and without Disabilities: A Nationwide, Population-Based Cohort Study. Vaccines. 2020; 8(1):112. https://doi.org/10.3390/vaccines8010112
Chicago/Turabian StyleChang, Yu-Chia, Ho-Jui Tung, Yu-Tung Huang, Chin-Te Lu, Ernawaty Ernawaty, and Szu-Yuan Wu. 2020. "Effect of Influenza Vaccination on Mortality and Risk of Hospitalization in Elderly Individuals with and without Disabilities: A Nationwide, Population-Based Cohort Study" Vaccines 8, no. 1: 112. https://doi.org/10.3390/vaccines8010112