Reduced Hospitalizations and Death Associated With Influenza Vaccination Among Patients With and Without Diabetes

Abstract

OBJECTIVE -To assess whether the influenza vaccination of community-dwelling, diabetic, elderly individuals is associated with reduced rates of hospitalization and death.RESEARCH DESIGN AND METHODS -In this outcome-research study, we compared mortality and hospitalization rates of 15,556 patients aged Ն65 years followed using a diabetes registry in a large health maintenance organization to that of 69,097 members not suffering from chronic disease who were considered as a reference group. The study outcomes included all-cause death and hospitalization in internal medicine or geriatric wards for any reason over winter and summer (control) periods.RESULTS -Vaccination rates were 48.8 and 42.0% among patients with diabetes and the reference population, respectively. Influenza vaccination was associated with a 12.3% reduction in hospitalization rates for patients with diabetes compared with 23.0% in the reference group (P ϭ 0.08). The reduction in hospitalization rates was similar in both sexes among patients with diabetes. In addition, there was a significant reduction in mortality for the vaccinated group of patients with diabetes when compared with the nonvaccinated group except for female patients aged Ն85 years.CONCLUSIONS -The study results support the use of influenza vaccine among an elderly population. However, there does not appear to be an additional benefit for patients with diabetes. Diabetes Care 27:2581-2584, 2004S erious complications of influenza among the elderly include pneumonia and exacerbations of coexisting conditions that can result in hospitalization and death (1). Vaccination against influenza has consistently been associated with reductions in hospitalizations for pneumonia and death from all causes in the elderly (2,3). It has been shown that vaccination of high-risk groups (e.g., patients with diabetes, renal disease, rheumatological disease, dementia, and stroke) reduced hospitalizations for respiratory conditions by 39% (4). In addition, the effectiveness of the influenza vaccine in reducing hospitalization due to cardiovascular and cerebrovascular causes and death from any reason has also been demonstrated (5).The few observational studies of diabetic subjects demonstrated up to 79% reduction in hospitalization rates (6,7).Although these studies were based on a small sample, they were sufficient for the Centers for Disease Control and Prevention to recommend inoculation with influenza vaccine for diabetic patients (8). Studies of the immunological responses have shown that influenza vaccine elicits comparable antibody responses in people with diabetes and control subjects (9,10) The aims of the current study were to assess whether the influenza vaccination of community-dwelling, diabetic, elderly individuals is associated with reduced rates of hospitalization and death. RESEARCH DESIGN AND METHODS -Maccabi HealthcareServices (MHS) is the second largest preferred provider organization in Israel, insuring 1.6 million members nationwide. According to the Israeli National Health Insurance...

Clinical Effectiveness of First and Repeat Influenza Vaccination in Adult and Elderly Diabetic Patients

“…In the present study, with good matching of the vaccine, a vaccine effectiveness estimate of 39% (though not significant) compares with the U.S. study (11). Heymann et al (12) did not find an additional benefit in patients with diabetes, but the study could be discussed because of the low influenza activity during the study season.…”

“…Hak et al (11) also found significant vaccine effectiveness among the subgroup of elderly individuals with diabetes with reductions in hospitalization for influenza or pneumonia or death from any cause ranging from 50% in one influenza season to 21% in the second season. In contrast, Heymann et al (12) did not find clinical effects of such vaccination in the subgroup of elderly individuals with diabetes.…”

Long-Term Immunogenicity and Safety of a Conventional Influenza Vaccine in Patients with Type 2 Diabetes

“…Diabetes is associated with impaired T cell function and disorders of humoral immunity (15). To our knowledge, only seven studies have been published regarding the immunogenicity of influenza vaccination among diabetic patients (6)(7)(8)(9)(10)(11)(12).…”

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