Keywords
Deprivation Index
Socioeconomic Status
Elderly
Abstract
Introduction
In Italy, vaccination against seasonal influenza has been recommended for the elderly since 1980, but coverage is still far below the WHO minimum target level of 75%. Effective interventions to improve influenza vaccination should understand which socioeconomic determinants may cause inequalities in vaccine uptake. This study aimed at assessing differences in vaccination coverage among people ≥65 years of age residing in the Foggia municipality, Italy, by socioeconomic status.
Methods
A Socio-Economic-Health Deprivation Index (SEHDI) was constructed using a multivariate analysis model. Resident population, for census block, was classified in 5 deprivation groups. Differences in demographic and socioeconomic indicators, the standardized mortality ratios (SMRs), and the average vaccination coverage among deprivation groups were evaluated with the linear F-test. The association between census variables and influenza vaccination coverage, in each deprivation group, was assessed using the Pearson bivariate correlation.
Results
The SEHDI allowed to identify factors related to ageing, housing, household size and composition, and education. Forty percent of people residing in the Foggia municipality lived in conditions of socioeconomic and health deprivation. Belonging to families with 3 or 4 members was associated with increased coverage rates. In the most deprived group, vaccination uptake was positively associated with the dependency ratio.
Conclusions
The results of this study have shown that there is still large room for improving influenza vaccination coverage among subjects belonging to the most deprived areas. Surveillance of trends in influenza vaccine uptake by socioeconomic groups is a feasible contribution to implementing effective, tailored to the frail older persons, vaccine utilization programs.
References
World Health Organization. Influenza (Seasonal). Available at: http://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal). Accessed on 3/8/2018.
Rizzo C, Viboud C, Montomoli E, Simonsen L, Miller MA. Influenza-related mortality in the Italian elderly: no decline associated with increasing vaccination coverage. Vaccine. 2006;24(42-43):6468-75. doi:10.1016/j.vaccine.2006.06.052.
Wang H, Fu C, Li K, Lu J, Chen Y, Lu E, Xiao X, Di B, Liu H, Yang Z, Wang M. Influenza associated mortality in Southern China, 2010-2012. Vaccine. 2014;32(8):973-8. doi: 10.1016/j.vaccine.2013.12.013.
Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, Cohen C, Gran JM, Schanzer D, Cowling BJ, Wu P, Kyncl J, Ang LW, Park M, Redlberger-Fritz M, Yu H, Espenhain L, Krishnan A, Emukule G, van Asten L, Pereira da Silva S, Aungkulanon S, Buchholz U, Widdowson MA, Bresee JS; Global Seasonal Influenza-associated Mortality Collaborator Network. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2018;391(10127):1285-1300. doi: 10.1016/S0140-6736(17)33293-2.
World Health Organization. Influenza Vaccines. Available at: http://www.who.int/influenza/vaccines/en/. Accessed on 4/8/2018.
Houser K, Subbarao K. Influenza Vaccines: Challenges and Solutions Cell Host Microbe. 2015; 17(3): 295–300. doi:10.1016/j.chom.2015.02.012.
World Health Organization. Influenza Vaccines Use. Available at: http://www.who.int/influenza/vaccines/use/en/. Accessed on 4/8/2018.
Council of the European Union. Council Recommendation of 22 December 2009 on seasonal influenza vaccination. Available at:http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2009:348:0071:0072:EN:PDF. Accessed: 11/06/2018.
Ministry of Health. Profilassi antinfluenzale. Raccomandazioni per la stagione 1989-1990. Circolare Ministeriale no. 28; 1989.
Portale dell’epidemiologia per la sanità pubblica. Coperture della vaccinazione antinfluenzale in Italia. Available at: http://www.epicentro.iss.it/problemi/influenza/coperturevaccinali.asp. Accessed on 6/08/2018.
Ministry of Health. National Vaccination Plan. Available at: http://www.salute.gov.it/portale/vaccinazioni/dettaglioContenutiVaccinazioni.jsp?lingua=italiano&id=4828&area=vaccinazioni&menu=vuoto. Accessed on 06/08/2018.
Ministry of health. Influenza vaccination Coverage. Available at: http://www.salute.gov.it/portale/influenza/dettaglioContenutiInfluenza.jsp?lingua=italiano&id=679&area=influenza&menu=vuoto. Accessed on 06/08/2018.
Osservatorio Epidemiologico Regionale – Puglia. Influenza. Available at: https://www.sanita.puglia.it/web/oer/influenza. Accessed on 07/08/2018.
Nagata JM, Hernández-Ramos I, Kurup AS, Albrecht D, Vivas-Torrealba C, Franco-Paredes C. Social determinants of health and seasonal influenza vaccination in adults ≥65 years: a systematic review of qualitative and quantitative data. BMC Public Health. 2013;13(1):388. doi:10.1186/1471-2458-13-388.
Falagas ME, Zarkadoulia E. Factors associated with suboptimal compliance to vaccinations in children in developed countries: a systematic review. Curr Med Res Opin. 2008;24(6):1719–41. doi:10.1185/03007990802085692.
Cabrera-Barona P, Murphy T, Kienberger S, Blaschke T. A multi-criteria spatial deprivation index to support health inequality analyses. Int J Health Geogr. 2015;14:11. doi: 10.1186/s12942-015-0004-x.
Caranci N, Costa G. Un indice di deprivazione a livello aggregato da utilizzare su scala nazionale: giustificazioni e composizione dell’indice. In: Costa G, Cislaghi C, Caranci N, editors. Disuguaglianze sociali di salute Problemi di definizione e di misura. 2009. p. 58–78.
Lillini R, Quaglia A, Vercelli M, Registro mortalità Regione Liguria. Building of a local deprivation index to measure the health status in the Liguria Region. Epidemiol Prev. 2012;36(3–4):180–7.
Damiani G, Federico B, Visca M, Agostini F, Ricciardi W. The impact of socioeconomic level on influenza vaccination among Italian adults and elderly: A cross-sectional study. Prev Med (Baltim). 2007;45(5):373–9. doi:10.1016/j.ypmed.2007.07.007.
Chiatti C, Di Rosa M, Barbadoro P, Lamura G, Di Stanislao F, Prospero E. Socioeconomic determinants of influenza vaccination among older adults in Italy. Prev Med (Baltim). 2010;51(3–4):332–3. doi:10.1016/j.ypmed.2010.06.008.
de Andres AL, Garrido PC, Hernandez-Barrera V, del Pozo SV-F, de Miguel AG, Jimenez-Garcia R. Influenza vaccination among the elderly Spanish population: trend from 1993 to 2003 and vaccination-related factors. Eur J Public Health. 2007;17(3):272–7. doi:10.1093/eurpub/ckl242.
Peretti-Watel P, Raude J, Sagaon-Teyssier L, Constant A, Verger P, Beck F. Attitudes toward vaccination and the H1N1 vaccine: Poor people’s unfounded fears or legitimate concerns of the elite? Soc Sci Med. 2014;109:10–8. doi:10.1016/j.socscimed.2014.02.035.
Topuzoglu A, Ozaydın GAN, Cali S, Cebeci D, Kalaca S, Harmanci H. Assessment of sociodemographic factors and socio-economic status affecting the coverage of compulsory and private immunization services in Istanbul, Turkey. Public Health. 2005;119(10):862–9. doi:10.1016/j.puhe.2005.01.015.
Istituto Nazionale di Statistica. Variabili censuarie per sezione di censimento. Avalaible at: http://datiopen.istat.it/datasetCOM.php#. Accessed on 07/08/2018.
Viaggiare in Puglia. Foggia. Available at: https://www.viaggiareinpuglia.it/at/154/localita/4164/en/Foggia-Foggia-(Foggia)?filtroMicroesperienzeRAArray=ASS_SPETTACOLIµes=si. Accessed on 07/08/2018.
Istituto Nazionale di Statistica. Available at: http://dati.istat.it/Index.aspx?lang=en&SubSessionId=dab9adaa-bd60-4889-a8fb-64510f98f383. Accessed on 07/08/2018.
Istituto Nazionale di Statistica. Available at: http://demo.istat.it/index_e.html. Accessed on 07/08/2018.
Istituto Nazionale di Statistica. Basi territoriali e variabili censuarie. Avalaible at: http://datiopen.istat.it/basiTerritoriali.php#. Accessed on 07/08/2018.
Artazcoz L, Rueda S. Social inequalities in health among the elderly: a challenge for public health research. J Epidemiol Community Health. 2007;61(6):466-7. doi:10.1136/jech.2006.058081.
Lallo C, Raitano M. Life expectancy inequalities in the elderly by socioeconomic status: evidence from Italy. Popul Health Metr. 2018;16(1):7. doi:10.1186/s12963-018-0163-7.
Paez A, Mercado RG, Farber S, Morency C, Roorda M. Accessibility to healthcare facilities in Montreal Island: an application of relative accessibility indicators from the perspective of senior and non-senior residents. Int J Health Geogr. 2010;9:52. doi:10.1186/1476-072X-9-52.
Bongue B, Colvez A, Amsallem E, Gerbaud L, Sass C. Assessment of Health Inequalities Among Older People Using the EPICES Score: A Composite Index of Social Deprivation. J Frailty Aging. 2016;5(3):168-173. PubMed PMID: 29240316. doi: 10.14283/jfa.2016.96.
Salze P, Banos A, Oppert J-M, Charreire H, Casey R, Simon C, Chaix B, Badariotti D, Weber C. Estimating spatial accessibility to facilities on the regional scale: an extended commuting based interaction potential model. Int J Health Geogr. 2011;10:2. doi:10.1186/1476-072X-10-2.
Aungkulanon S, Tangcharoensathien V, Shibuya K, Bundhamcharoen K, Chongsuvivatwong V. Area-level socioeconomic deprivation and mortality differentials in Thailand: results from principal component analysis and cluster analysis. Int J Equity Health. 2017;16(1):117. Published 2017 Jul 3. doi:10.1186/s12939-017-0613.
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, Kunst AE; European Union Working Group on Socioeconomic Inequalities in Health. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008 Jun 5;358(23):2468-81. doi: 10.1056/NEJMsa0707519. Erratum in: N Engl J Med. 2008;359(12):e14. doi: 10.1056/NEJMsa0707519.
Lovasi GS, Diez Roux AV, Hoffman EA, Smith LJ, Jiang R, Carr JJ, Barr RG. Socioeconomic status is positively associated with percent emphysema on CT scan: The MESA lung study. Acad Radiol. 2011;18(2):199-204. doi:10.1016/j.acra.2010.10.010.
Witte KK, Patel PA, Walker AMN, Schechter CB, Drozd M, Sengupta A, Byrom R, Kearney LC, Sapsford RJ, Kearney MT1, Cubbon RM. Socioeconomic deprivation and mode-specific outcomes in patients with chronic heart failure. Heart. 2018;104(12):993-998. doi: 10.1136/heartjnl-2017-312539.
Zhao H, Harris RJ, Ellis J, Pebody RG. Ethnicity, deprivation and mortality due to 2009 pandemic influenza A(H1N1) in England during the 2009/2010 pandemic and the first post-pandemic season. Epidemiol Infect. 2015 Dec;143(16):3375-83. doi: 10.1017/S0950268815000576.
Khieu TQT, Pierse N, Telfar-Barnard LF, Zhang J, Huang QS, Baker MG. Modelled seasonal influenza mortality shows marked differences in risk by age, sex, ethnicity and socioeconomic position in New Zealand. J Infect. 2017;75(3):225-233. doi: 10.1016/j.jinf.2017.05.017.
Landi F, Onder G, Carpenter I, Garms-Homolova V, Bernabei R. Prevalence and predictors of influenza vaccination among frail, community-living elderly patients: an international observational study. Vaccine. 2005;23(30):3896-901. doi: 10.1016/j.vaccine.2005.03.008.
Norbury M, Fawkes N, Guthrie B. Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis. Br J Gen Pract. 2011;61(588):e379-85. doi: 10.3399/bjgp11X583146.