Identification of Barriers to Influenza Vaccination in Patients with Chronic Obstructive Pulmonary Disease: Analysis of the 2012 Behavioral Risk Factors Surveillance Survey

Abstract

Introduction Patients with chronic obstructive pulmonary disease (COPD) are at increased risk for influenza-related morbidity and mortality. Influenza vaccination is known to decrease influenza incidence, severity, hospitalizations, and mortality. Identification of barriers to influenza vaccination among patients with COPD may aid in efforts to increase vaccination rates. This study aims to identify predictors of influenza vaccination in COPD patients. Methods This study used data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS). Participants with self-reported COPD and receiving an influenza vaccination in the prior 12 months were identified. Independent predictors of the exposure were identified by estimating a parsimonious logistic regression model of influenza vaccination. All analyses were performed using weighted data. Results The final study sample consisted of 36,811 COPD participants, with 48.5% of COPD patients reporting having been vaccinated and 51.5% reporting being unvaccinated. A total of 15 independent predictors of influenza vaccination in COPD patients were identified. Negative predictors included predisposing factors (younger age, male gender, household children, black or non-white/non-Hispanic/non-black race/ethnicity, lower education level, heavy alcohol use, current tobacco use) and enabling factors that reflect access to medical care (insurance status, ability to afford care, having a recent check-up). Positive predictors of influenza vaccination included need factors (chronic comorbidities), being a military veteran, or being a former smoker. Conclusions This analysis identifies multiple predictors of influenza vaccination in persons with COPD. Identification of at risk-groups provides the foundation for development of focused efforts to improve influenza vaccination rates in patients with COPD.

<p>Risk factors associated with physical and mental distress in people who report a COPD diagnosis: latent class analysis of 2016 behavioral risk factor surveillance system data</p>

“…Among the 60% of people with COPD in the low risk (high use) class for preventive vaccinations, almost all reported receiving the pneumonia vaccination (99.5%), yet only about half (55.3%) obtained their annual flu vaccination. Prior analyses of 2012 BRFSS data showed that close to 50% of patients with COPD were not vaccinated against influenza,11,66 which is similar to the flu vaccine rate reported here. The target HP 2020 recommendation for flu vaccination is 90% for adults living with chronic conditions 67.…”

“…Despite evidence that if a patient quits smoking, the patient can slow down the decline of lung functioning and can improve their chance of surviving COPD,8 nearly 40% of patients with COPD continue to smoke after a COPD diagnosis 9. Similarly, it is a national priority to promote flu vaccine uptake against respiratory viruses among patients with COPD;10 however, over half (51.5%) of patients with COPD in the United States report never receiving an influenza vaccination 11. Given their poor disease management practices, patients with COPD who smoke or have contracted the influenza virus experience negative health-related outcomes that compromise their quality of living 12,13.…”

“…Given their poor disease management practices, patients with COPD who smoke or have contracted the influenza virus experience negative health-related outcomes that compromise their quality of living 12,13. Observational studies identify smoking status and contracting influenza as predictors of one another,11 making it difficult to assess their temporal relationship and unique contribution to emotional and physical distress. There is limited evidence that examines how sociocultural behavioral and health risk factors, including smoking behaviors and vaccine avoidance, contribute to the physical and mental distress experienced by people with COPD in the United States.…”

Which factors effects patients belief and attitudes about influenza vaccination?

“…Ancak kronik akciğer hastalığı bulunan olgular göz önüne alındığında kadınların erkeklere göre daha yüksek oranda influenza aşısı olduğu görülmüştür. Benzer şekilde KOAH hastalarıyla yapılan bir araştırmada çok değişkenli regresyon analizinde erkek cinsiyetin aşılanma üzerine negatif etkili bir bağımsız değişken olduğu ve kadın olguların daha yüksek oranda aşılandıkları bulunmuştur(17).Yayınlanmış araştırmalarla uyumlu şekilde influenza aşısı ile aşılanma oranları pnömokok aşısı ile aşılanma oranlarından daha yüksek bulundu(18). Mevsimsel influenza aşısı pnömokok aşısından daha uzun süreden beri önerildiği için hem hekimlerin hem de hastaların influenza aşısı hakkında farkındalığı daha fazla olabilir.Araştırmamızın kısıtlılıklarından biri aşılanma oranlarının hastaların kendilerinin cevapladıkları anket sonucu belirlenmesi ve eczane bilgisiyle teyit edilmemesidir.…”

Barriers to Influenza Immunization

“…This is not the first-time barriers to influenza immunization have been examined (9,10). However, studies in Iran based on our culture and economic situation is scarce (11).…”