Annual revaccination against influenza and mortality risk in community-dwelling elderly parsons

被引:118
作者
Voordouw, ACG
Sturkenboom, MCJM
Dieleman, JP
Stijnen, T
Smith, DJ
van der Lei, J
Stricker, BHC
机构
[1] Erasmus Univ, Med Ctr, Dept Epidemiol & Biostat, NL-3000 DR Rotterdam, Netherlands
[2] Erasmus Univ, Med Ctr, Dept Internal Med, Pharmacoepidemiol Unit, Rotterdam, Netherlands
[3] Erasmus Univ, Med Ctr, Dept Med Informat, Rotterdam, Netherlands
[4] Erasmus Univ, Med Ctr, Dept Virol, Rotterdam, Netherlands
[5] Inspectorate Hlth Care, Med Evaluat Board, The Hague, Netherlands
[6] Inspectorate Hlth Care, Drug Safety Unit, The Hague, Netherlands
[7] Univ Cambridge, Dept Zool, Cambridge, England
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2004年 / 292卷 / 17期
关键词
D O I
10.1001/jama.292.17.2089
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Although large-scale observational studies have demonstrated the effectiveness of influenza vaccination, no large studies have systematically addressed the clinical benefit of annual revaccinations. Objective To investigate the effect of annual influenza revaccination on mortality in community-dwelling elderly persons. Design, Setting, and Participants A population-based cohort study using the computerized Integrated Primary Care Information (IPCI) database in the Netherlands including community-dwelling individuals aged 65 years or older from 1996 through 2002. For each year, we computed the individual cumulative exposure to influenza vaccination since study start. Main Outcome Measure Association between the number of consecutive influenza vaccinations and all-cause mortality vs no vaccination after adjusting forage, sex, chronic respiratory and cardiovascular disease, hypertension, diabetes mellitus, renal failure, and cancer. Results The study population included 26071 individuals, of whom 3485 died during follow-up. Overall, a first vaccination was associated with a nonsignificant annual reduction of mortality risk of 10% (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.78-1.03) while revaccination was associated with a reduced mortality risk of 24% (HR, 0.76; 95% Cl, 0.70-0.83). Compared with a first vaccination, revaccination was associated with a reduced annual mortality risk of 15% (HR, 0.85; 95% Cl, 0.75-0.96). During the epidemic periods this reduction was 28% (HR, 0.72; 95% Cl, 0.53-0.96). Similar estimates were obtained for persons with and without chronic comorbidity and those aged 70 years or older at baseline. overall, influenza vaccination is estimated to prevent 1 death for every 302 vaccinees at a vaccination coverage that varied between 64% and 74%. Conclusion Annual influenza vaccination is associated with a reduction in all-cause mortality risk in a population of community-dwelling elderly persons, particularly in older individuals.
引用
收藏
页码:2089 / 2095
页数:7
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