tetano
Editor, Senior Moderator
Am J Kidney Dis
. 2023 Sep 15;S0272-6386(23)00799-0.
doi: 10.1053/j.ajkd.2023.06.007. Online ahead of print. Factors Associated With Non-Vaccination for Influenza Among Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
Junichi Ishigami[SUP] 1 [/SUP], Bernard G Jaar[SUP] 2 [/SUP], Jeanne B Charleston[SUP] 3 [/SUP], James P Lash[SUP] 4 [/SUP], Julia Brown[SUP] 4 [/SUP], Jing Chen[SUP] 5 [/SUP], Katherine T Mills[SUP] 6 [/SUP], Jonathan Taliercio[SUP] 7 [/SUP], Sheru Kansal[SUP] 8 [/SUP], Deidra C Crews[SUP] 9 [/SUP], Kristin A Riekert[SUP] 10 [/SUP], David W Dowdy[SUP] 3 [/SUP], Lawrence J Appel[SUP] 11 [/SUP], Kunihiro Matsushita[SUP] 11 [/SUP]; CRIC Study investigators
Affiliations
Rationale & objective: Vaccination for influenza is strongly recommended for people with chronic kidney disease (CKD) due to their immunocompromised state. Identifying risk factors for not receiving an influenza vaccine ("non-vaccination") could inform strategies for improving vaccine uptake in this high-risk population.
Study design: Longitudinal observational study.
Setting: & Participants: 3,692 Chronic Renal Insufficiency Cohort Study (CRIC) participants.
Exposures: Demographic factors, social determinants of health, clinical conditions, and health behaviors.
Outcome: Influenza non-vaccination, which was assessed based on a receipt of influenza vaccine ascertained during annual clinic visits in a subset of participants who were under nephrology care.
Analytical approach: Mixed-effects Poisson models to estimate adjusted prevalence ratios (aPRs).
Results: Between 2009 and 2020, the pooled mean vaccine uptake was 72% (mean age, 66 years; 44% female; 44% Black race). In multivariable models, factors significantly associated with influenza non-vaccination were younger age (aPR, 2.16 [95%CI, 1.85-2.52] for <50 vs. ≥75 years), Black race (1.58 [1.43-1.75] vs. White race), lower education (1.20 [1.04-1.39 for less than high school vs. college graduate]), lower annual household income (1.26 [1.06-1.49] for <$20,000 vs. >$100,000), formerly married status (1.22 [1.09 to 1.35] vs. currently married), and non-employed status (1.13 [1.02-1.24] vs. employed). In contrast, participants with diabetes (aPR, 0.80 [95%CI, 0.73-0.87] vs. no diabetes), chronic obstructive pulmonary disease (COPD) (0.80 [0.70-0.92] vs. no COPD), end-stage kidney disease (0.64 [0.56 to 0.76] vs. estimated glomerular filtration rate ≥60 ml/min/1.73m[SUP]2[/SUP]), frailty (0.86 [0.74-0.99] vs. no frailty), and ideal physical activity (0.90 [0.82-0.99] vs. physically inactive) were less likely to have non-vaccination status.
Limitations: Possible residual confounding CONCLUSION: Among adults with CKD receiving nephrology care, younger adults, Black individuals, and those with adverse social determinants of health were more likely to have the influenza non-vaccination status. Strategies are needed to address these disparities and reduce barriers to vaccination.
Keywords: Chronic Kidney Disease; Infectious Disease; Influenza; Vaccination.
. 2023 Sep 15;S0272-6386(23)00799-0.
doi: 10.1053/j.ajkd.2023.06.007. Online ahead of print. Factors Associated With Non-Vaccination for Influenza Among Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study
Junichi Ishigami[SUP] 1 [/SUP], Bernard G Jaar[SUP] 2 [/SUP], Jeanne B Charleston[SUP] 3 [/SUP], James P Lash[SUP] 4 [/SUP], Julia Brown[SUP] 4 [/SUP], Jing Chen[SUP] 5 [/SUP], Katherine T Mills[SUP] 6 [/SUP], Jonathan Taliercio[SUP] 7 [/SUP], Sheru Kansal[SUP] 8 [/SUP], Deidra C Crews[SUP] 9 [/SUP], Kristin A Riekert[SUP] 10 [/SUP], David W Dowdy[SUP] 3 [/SUP], Lawrence J Appel[SUP] 11 [/SUP], Kunihiro Matsushita[SUP] 11 [/SUP]; CRIC Study investigators
Affiliations
- PMID: 37717847
- DOI: 10.1053/j.ajkd.2023.06.007
Rationale & objective: Vaccination for influenza is strongly recommended for people with chronic kidney disease (CKD) due to their immunocompromised state. Identifying risk factors for not receiving an influenza vaccine ("non-vaccination") could inform strategies for improving vaccine uptake in this high-risk population.
Study design: Longitudinal observational study.
Setting: & Participants: 3,692 Chronic Renal Insufficiency Cohort Study (CRIC) participants.
Exposures: Demographic factors, social determinants of health, clinical conditions, and health behaviors.
Outcome: Influenza non-vaccination, which was assessed based on a receipt of influenza vaccine ascertained during annual clinic visits in a subset of participants who were under nephrology care.
Analytical approach: Mixed-effects Poisson models to estimate adjusted prevalence ratios (aPRs).
Results: Between 2009 and 2020, the pooled mean vaccine uptake was 72% (mean age, 66 years; 44% female; 44% Black race). In multivariable models, factors significantly associated with influenza non-vaccination were younger age (aPR, 2.16 [95%CI, 1.85-2.52] for <50 vs. ≥75 years), Black race (1.58 [1.43-1.75] vs. White race), lower education (1.20 [1.04-1.39 for less than high school vs. college graduate]), lower annual household income (1.26 [1.06-1.49] for <$20,000 vs. >$100,000), formerly married status (1.22 [1.09 to 1.35] vs. currently married), and non-employed status (1.13 [1.02-1.24] vs. employed). In contrast, participants with diabetes (aPR, 0.80 [95%CI, 0.73-0.87] vs. no diabetes), chronic obstructive pulmonary disease (COPD) (0.80 [0.70-0.92] vs. no COPD), end-stage kidney disease (0.64 [0.56 to 0.76] vs. estimated glomerular filtration rate ≥60 ml/min/1.73m[SUP]2[/SUP]), frailty (0.86 [0.74-0.99] vs. no frailty), and ideal physical activity (0.90 [0.82-0.99] vs. physically inactive) were less likely to have non-vaccination status.
Limitations: Possible residual confounding CONCLUSION: Among adults with CKD receiving nephrology care, younger adults, Black individuals, and those with adverse social determinants of health were more likely to have the influenza non-vaccination status. Strategies are needed to address these disparities and reduce barriers to vaccination.
Keywords: Chronic Kidney Disease; Infectious Disease; Influenza; Vaccination.