A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom General Practice Research Database
A cohort study of the effectiveness of influenza vaccine in older people, performed using the United Kingdom General Practice Research Database
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DOI：
10.1086/421274
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发表时间：
2004-07-01
影响因子：
6.4
通讯作者：
Hall, AJ
中科院分区：
文献类型：
--
作者：
Mangtani, P;Cumberland, P;Hall, AJ
背景流感疫苗对住院和死亡的有效性只能在观察性研究中进行伦理评估。一个令人担忧的问题是，接种疫苗的人比未接种疫苗的人更健康，可能会使有效性的估计值偏高。我们对64岁以上的个体进行了一项历史队列研究，在英格兰和威尔士的全科医学研究数据库中有1989年至1999年的数据。在692，819人-年的疫苗接种者和1，534，280人-年的疫苗非接种者中，比较了急性呼吸道疾病的入院率和呼吸道疾病的死亡率。疫苗对急性呼吸道疾病住院的合并有效性为21%（95%置信区间[CI]，17%-26%）。在流感季节，疫苗接种导致的住院率下降为4.15例/100 000人周。在疫苗接种者中，在流感季节之外，入院人数没有明显减少。疫苗对呼吸道疾病死亡的合并有效性为12%（95% CI，8%-16%）。在没有医学疾病的人群中观察到更大比例的减少，但与没有此类疾病的个体相比，患有医学疾病的个体的绝对率减少更高（6.14例因呼吸系统疾病死亡/100，000人周vs. 3.12例因呼吸系统疾病死亡/100，000人周）。没有看到对所有原因导致的死亡的明确保护。流感疫苗接种减少了因呼吸系统疾病住院和死亡的人数，在对具有流感高风险或低风险的64岁以上个体的混杂因素进行校正后。对于老年人来说，非靶向流感疫苗接种对严重后果具有确认的益处。
Background. The effectiveness of influenza vaccination against hospitalization and death can only ethically be assessed in observational studies. A concern is that individuals who are vaccinated are healthier than individuals who are not vaccinated, potentially biasing estimates of effectiveness upward.Methods. We conducted a historical cohort study of individuals >64 years of age, for whom there were data available in the General Practice Research Database for 1989 to 1999 in England and Wales. Rates of admissions for acute respiratory diseases and rates of death due to respiratory disease were compared over 692,819 person-years in vaccine recipients and 1,534,280 person-years in vaccine nonrecipients.Results. The pooled effectiveness of vaccine against hospitalizations for acute respiratory disease was 21% (95% confidence interval [CI], 17%-26%). The rate reduction attributable to vaccination was 4.15 hospitalizations/100,000 person-weeks in the influenza season. Among vaccine recipients, no important reduction in the number of admissions to the hospital was seen outside influenza seasons. The pooled effectiveness of vaccine against deaths due to respiratory disease was 12% ( 95% CI, 8%-16%). A greater proportionate reduction was seen among people without medical disorders, but absolute rate reduction was higher in individuals with medical disorders, compared with individuals without such disorders (6.14 deaths due to respiratory disease/100,000 person-weeks vs. 3.12 deaths due to respiratory disease/100,000 person-weeks). Clear protection against death due to all causes was not seen.Conclusions. Influenza vaccination reduces the number of hospitalizations and deaths due to respiratory disease, after correction for confounding in individuals >64 years of age who had a high risk or a low risk for influenza. For elderly people, untargeted influenza vaccination is of confirmed benefit against serious outcomes.