Influenza vaccination and all-cause mortality in community-dwelling elderly in Ontario, Canada, a cohort study
Influenza vaccination and all-cause mortality in community-dwelling elderly in Ontario, Canada, a cohort study
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DOI：
10.1016/j.vaccine.2010.10.049
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发表时间：
2010-12-16
期刊：
影响因子：
5.5
通讯作者：
Kwong, Jeffrey C.
中科院分区：
文献类型：
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作者：
Campitelli, Michael A.;Rosella, Laura C.;Kwong, Jeffrey C.
本研究的目的是评估流感疫苗在降低社区老年人全因死亡率方面的有效性。我们纳入了 25,922 名 65 岁以上的安省居民，他们对人口健康调查做出了回应。经过全面调整后，流感疫苗接种与流感季节全因死亡率显着降低具有统计学意义（风险比 (HR) = 0.61；95% Cl 0.47-0.79）。与预期相反，在流感季节之前（HR = 0.55；95% CI 0.40-0.75）和流感季节之后（HR = 0.74：95% CI 0.59-0.94）期间也观察到流感疫苗接种与死亡率之间存在统计学显着关联，表明存在残余混杂因素。对功能状态指标的调整、排除基线一年预测死亡率较高的个体以及改变随访开始日期未能消除难治性混杂因素。由于观察性研究容易出现偏差，未来估计老年人疫苗有效性的努力应努力通过提高数据质量、新的数据源和/或新的分析技术来尽量减少偏差。 (C) 2010 Elsevier Ltd. 保留所有权利。
The objective of this study was to evaluate the effectiveness of influenza vaccines in reducing all-cause mortality among community-dwelling elderly. We included 25,922 Ontario residents over age 65 who responded to population health surveys. After full adjustment, influenza vaccination was associated with a statistically significant reduction in all-cause mortality during influenza seasons (hazard ratio (HR) = 0.61; 95% Cl 0.47-0.79). Contrary to expectations, statistically significant associations between influenza vaccination and mortality were also observed during periods preceding (HR = 0.55; 95% Cl 0.40-0.75) and following (HR = 0.74:95% CI 0.59-0.94) influenza seasons, indicating the presence of residual confounding. Adjustment for functional status indicators, excluding individuals with high one-year predicted mortality at baseline, and moving the start date of follow-up failed to eliminate the refractory confounding. Since observational studies are prone to bias, future efforts to estimate vaccine effectiveness in the elderly should strive to minimize bias through improved data quality, novel data sources, and/or new analytical techniques. (C) 2010 Elsevier Ltd. All rights reserved.