Elderly use to develop more complications after influenza and the 90% of deaths for influenza regards them. Indeed, they are among the major target of vaccination campaigns. The use of deprivation indices can help to identify subgroups with lower vaccine uptake. This work was aimed to analyze vaccination coverage of elderly living in Genoa using a local Index of Socio-Economic and Health Deprivation (SEHDI) in order to identify subgroups of population needing specific actions to improve vaccination coverage.
The target population was the population aged ≥65 years living in Genoa in the 2009-2013 period. Information about vaccination coverage derived from general practitioners. A combination of linear regression, factor analysis and cluster analysis was used to build the SEHDI at Census Tract (CT) level, deriving data from the 2011 Italian census.
In Genoa, in 2011, people aged ≥65 years represented the 27.7% of the population. The majority of elderly belonged to medium (45.3%) and medium-high (32%) deprivation groups, while the percentages in the extreme tails were low (3.6% high deprived; 1.3% low deprived). Significant not linear (p<0.05 NL) relationships were observed in both sexes for all respiratory diseases (RD) and COPD mortality, with the highest SMRs values in the high deprivation group of women (1.81, p<0.05 RD; 1.79, p<0.05 COPD). The SMRs for influenza and pneumonia showed a linear positive trend in women (p<0.05), with the highest value in the high deprived (1.97, p<0.05), while in men the trend was NL (p<0.05). A positive linear trend (p<0.05) was found for vaccination coverage, weakly growing at deprivation increase until the medium-high deprived group (from 34.6% to 44.4%), but the high deprivation group showed the lowest value (33,3%).
The results displayed a positive relationship between deprivation and vaccination coverage. This finding should be taken into account in the organization of vaccination campaigns and should call for differentiated actions in each small areas.
Gordon G. The concept of deprivation. Quality of life and human welfare. Proc. 3rd Royal Scottish Geographical Society symposium. 1984:15-21.
Townsend P, Phillimore P, Beattie A. Health and Deprivation: Inequality and the North. London, Routledge. 1988.
Carstairs V, Morris R. Deprivation and Health in Scotland. Aberdeen, Aberdeen University Press. 1991.
Venerandi A, Quattrone G, Capra L. A scalable method to quantify the relationship between urban form and socio-economic indexes. EPJ Data Science. 2018; 7(1).
Ministero della Salute. Prevenzione e controllo dell’influenza. http://www.salute.gov.it/portale/influenza/ dettaglioContenutiInfluenza.jsp?lingua=italiano&id=685&area=influenza&menu=vuoto.
Rapporto epidemiologico InfluNet N. 26 del 7 maggio 2018.
Istituto Nazionale di statistica. Cause di Morte, Anno 2000. ISTAT editor. Annuario 16, 2004. ISTAT.
Francia F, Pandolfi P, Odone A, Signorelli C. Excess mortality in Italy: Should we care about low influenza vaccine uptake? Scand J Public Health. 2018;46(2):170-174.
Piano Sanitario Nazionale 1998-2000. http://www.salute.gov.it/imgs/C_17_pubblicazioni_947_ allegato.pdf
Piano Nazionale Prevenzione Vaccinale 2012-2014. http://www.salute.gov.it/imgs/C_17_pubblicazioni_ 1721_allegato.pdf.
Piano Nazionale Prevenzione Vaccinale 2017-2019. http://www.salute.gov.it/imgs/C_17_pubblicazioni_ 2571_allegato.pdf.
Vaccinazione antinfluenzale in Italia: coperture vaccinali negli anziani (età >= 65 anni) (per 100 abitanti). Stagioni 1999‐2000/2017‐2018. http://www.salute.gov.it/imgs/C_17_tavole_19_allegati_iitem Allegati_0_fileAllegati_itemFile_3_file.pdf.
Manzoli L, Gabutti G, Siliquini R, Flacco ME, Villari P, Ricciardi W. Association between vaccination coverage decline and influenza incidence rise among Italian elderly. Eur J Public Health. 2018 1;28(4):740-742.
Vestergaard LS, Nielsen J, Krause TG, Espenhain L, Tersago K, Bustos Sierra N, Denissov G, Innos K, Virtanen MJ, Fouillet A, Lytras T, Paldy A, Bobvos J, Domegan L, O'Donnell J, Scortichini M, de Martino A, England K, Calleja N, van Asten L, Teirlinck AC, Tønnessen R, White RA, P Silva S, Rodrigues AP, Larrauri A, Leon I, Farah A, Junker C, Sinnathamby M, Pebody RG, Reynolds A, Bishop J, Gross D, Adlhoch C, Penttinen P, Mølbak K. Excess all-cause and influenza-attributable mortality in Europe, December 2016 to February 2017.Euro Surveill. 2017 6;22(14).
Michelozzi P, De' Donato F, Scortichini M, De Sario M, Asta F, Agabiti N, Guerra R, de Martino A, Davoli M. [On the increase in mortality in Italy in 2015: analysis of seasonal mortality in the 32 municipalities included in the Surveillance system of daily mortality]. Epidemiol Prev. 2016;40(1):22-8.
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; 13:388.
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;119:862–869.
Coupland C, Harcourt S, Vinogradova Y, Smith G, Joseph C, Pringle M, Hippisley-Cox J. Inequalities in uptake of influenza vaccine by deprivation and risk group: time trends analysis. Vaccine. 2007;25(42): 7363–7371.
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.
Breeze E, Mangtani P, Fletcher AE, Price GM, Kovats SJR. Trends in influenza vaccination uptake among people aged over 74 years 1997–2000: survey of 73 general practices in Britain. BMC Family Practice 2004;5:8.
Pasetto R, Caranci N, Pirastu R. L’indice di deprivazione negli studi di piccola area su ambiente e salute. Deprivation indices in small-area studies of environment and health in Italy. Epidemiol Prev. 2011; 35 (5-6) Suppl. 4: 1-204.
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]. [Article in Italian] Epidemiol Prev. 2012;36(3-4):180-187.
Tacq J. Multivariate Analysis Techniques in Social Science Research. London, Sage; 1997.
Lee AA, Piette JD, Heisler M, Janevic MR, Langa KM, Rosland AM. Family members' experiences supporting adults with chronic illness: A national survey. Fam Syst Health. 2017;35(4):463-473.
Casanova G, Lamura G, Principi A. Valuing and Integrating Informal Care as a Core Component of Long-Term Care for Older People: A Comparison of Recent Developments in Italy and Spain. J Aging Soc Policy. 2017;29(3):201-217.
Battilani P. The ‘Bel Paese’ and the transition to a service economy. Journal of Modern Italian Studies. 2010;15(1):21-40.
Pastuszka S. Regional Differentiation of The Demographic Potential in Italy and Poland. Comparative Economic Research. 2017;20(3):137-159.
Marí-Dell’Olmo M, Gotsens M, Palència L, Burström B, Corman D, Costa G, Deboosere P, Díez È, Domínguez-Berjón F, Dzúrová D, Gandarillas A, Hoffmann R, Kovács K, Martikainen P, Demaria M, Pikhart H, Rodríguez-Sanz M, Saez M, Santana P, Schwierz C, Tarkiainen L, Borrell C. Socioeconomic inequalities in cause-specific mortality in 15 European cities. J Epidemiol Community Health 2015;0:1–10.
C Marinacci, T Spadea, A Biggeri, M Demaria, A Caiazzo, G Costa. The role of individual and contextual socioeconomic circumstances on mortality: analysis of time variations in a city of north west Italy. J Epidemiol Community Health 2004;58:199–207.
Mangtani P, Breeze E, Kovats S, Ng ESW, Roberts JA, Fletcher A. Inequalities in influenza vaccine uptake among people aged over 74 years in Britain. Prev Med (Baltim) 2005;41:545–53.
Cano Gutierrez C, Reyes-Ortiz C, Borda MG, Arciniegas A. Self-reported vaccination in the elderly: SABE Bogota study, Colombia. Colomb medica (Cali, Colombia) 2016;47:25–30
Böhmer MM, Walter D, Krause G, Müters S, Gösswald A, Wichmann O. Determinants of tetanus and seasonal influenza vaccine uptake in adults living in Germany. Hum Vaccin 2011;7:1317–25.
Signorelli C, Odone A, Conversano M,Bonanni P . Deaths after Fluad flu vaccine and the epidemic of panic in Italy. BMJ 2015;350:h116.
Larson HJ, Cooper LZ, Eskola J, Katz SL, Ratzan S. Addressing the vaccine confidence gap. Lancet 2011; 378:526–35.