High-dose influenza vaccination and mortality among predominantly male, white, senior veterans, United States, 2012/13 to 2014/15

IntroductionIt is unclear whether high-dose influenza vaccine (HD) is more effective at reducing mortality among seniors.AimThis study aimed to evaluate the relative vaccine effectiveness (rVE) of HD. MethodsWe linked electronic medical record databases in the Veterans Health Administration (VHA) an...

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Veröffentlicht in:Euro surveillance : bulletin européen sur les maladies transmissibles 2020-05, Vol.25 (19)
Hauptverfasser: Young-Xu, Yinong, Thornton Snider, Julia, Mahmud, Salaheddin M, Russo, Ellyn M, Van Aalst, Robertus, Thommes, Edward W, Lee, Jason Kh, Chit, Ayman
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container_issue 19
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container_title Euro surveillance : bulletin européen sur les maladies transmissibles
container_volume 25
creator Young-Xu, Yinong
Thornton Snider, Julia
Mahmud, Salaheddin M
Russo, Ellyn M
Van Aalst, Robertus
Thommes, Edward W
Lee, Jason Kh
Chit, Ayman
description IntroductionIt is unclear whether high-dose influenza vaccine (HD) is more effective at reducing mortality among seniors.AimThis study aimed to evaluate the relative vaccine effectiveness (rVE) of HD. MethodsWe linked electronic medical record databases in the Veterans Health Administration (VHA) and Medicare administrative files to examine the rVE of HD vs standard-dose influenza vaccines (SD) in preventing influenza/pneumonia-associated and cardiorespiratory mortality among VHA-enrolled veterans 65 years or older during the 2012/13, 2013/14 and 2014/15 influenza seasons. A multivariable Cox proportional hazards model was performed on matched recipients of HD vs SD, based on vaccination time, location, age, sex, ethnicity and VHA priority level. ResultsAmong 569,552 person-seasons of observation, 207,574 (36%) were HD recipients and 361,978 (64%) were SD recipients, predominantly male (99%) and white (82%). Pooling findings from all three seasons, the adjusted rVE estimate of HD vs SD during the high influenza periods was 42% (95% confidence interval (CI): 24-59) against influenza/pneumonia-associated mortality and 27% (95% CI: 23-32) against cardiorespiratory mortality. Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10-62) and 25% (95% CI: 12-38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. These were confirmed by results from two-stage residual inclusion estimations.DiscussionThe HD was associated with a lower risk of influenza/pneumonia-associated and cardiorespiratory death in men during the high influenza period.
doi_str_mv 10.2807/1560-7917.ES.2020.25.19.1900401
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MethodsWe linked electronic medical record databases in the Veterans Health Administration (VHA) and Medicare administrative files to examine the rVE of HD vs standard-dose influenza vaccines (SD) in preventing influenza/pneumonia-associated and cardiorespiratory mortality among VHA-enrolled veterans 65 years or older during the 2012/13, 2013/14 and 2014/15 influenza seasons. A multivariable Cox proportional hazards model was performed on matched recipients of HD vs SD, based on vaccination time, location, age, sex, ethnicity and VHA priority level. ResultsAmong 569,552 person-seasons of observation, 207,574 (36%) were HD recipients and 361,978 (64%) were SD recipients, predominantly male (99%) and white (82%). Pooling findings from all three seasons, the adjusted rVE estimate of HD vs SD during the high influenza periods was 42% (95% confidence interval (CI): 24-59) against influenza/pneumonia-associated mortality and 27% (95% CI: 23-32) against cardiorespiratory mortality. Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10-62) and 25% (95% CI: 12-38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. These were confirmed by results from two-stage residual inclusion estimations.DiscussionThe HD was associated with a lower risk of influenza/pneumonia-associated and cardiorespiratory death in men during the high influenza period.</description><identifier>ISSN: 1560-7917</identifier><identifier>ISSN: 1025-496X</identifier><identifier>EISSN: 1560-7917</identifier><identifier>DOI: 10.2807/1560-7917.ES.2020.25.19.1900401</identifier><identifier>PMID: 32431290</identifier><language>eng</language><publisher>Sweden: European Centre for Disease Prevention and Control (ECDC)</publisher><subject>Aged ; Aged, 80 and over ; Dose-Response Relationship, Drug ; Drug-Related Side Effects and Adverse Reactions ; Electronic Health Records ; European Continental Ancestry Group ; Humans ; Influenza Vaccines - administration &amp; dosage ; Influenza Vaccines - adverse effects ; Influenza Vaccines - immunology ; Influenza, Human - ethnology ; Influenza, Human - mortality ; Influenza, Human - prevention &amp; control ; Male ; Medicare ; Pneumonia - ethnology ; Pneumonia - mortality ; Pneumonia - prevention &amp; control ; Seasons ; Survival Analysis ; United States - epidemiology ; Vaccination - methods ; Vaccination - mortality ; Veterans - statistics &amp; numerical data</subject><ispartof>Euro surveillance : bulletin européen sur les maladies transmissibles, 2020-05, Vol.25 (19)</ispartof><rights>This article is copyright of the authors or their affiliated institutions, 2020. 2020 The authors or their affiliated institutions</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-69eb78ce7d850a9bc3aa0d0b853de33fa62d51e71eb3122c636363aa6b3667f93</citedby><cites>FETCH-LOGICAL-c441t-69eb78ce7d850a9bc3aa0d0b853de33fa62d51e71eb3122c636363aa6b3667f93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238741/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7238741/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32431290$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Young-Xu, Yinong</creatorcontrib><creatorcontrib>Thornton Snider, Julia</creatorcontrib><creatorcontrib>Mahmud, Salaheddin M</creatorcontrib><creatorcontrib>Russo, Ellyn M</creatorcontrib><creatorcontrib>Van Aalst, Robertus</creatorcontrib><creatorcontrib>Thommes, Edward W</creatorcontrib><creatorcontrib>Lee, Jason Kh</creatorcontrib><creatorcontrib>Chit, Ayman</creatorcontrib><title>High-dose influenza vaccination and mortality among predominantly male, white, senior veterans, United States, 2012/13 to 2014/15</title><title>Euro surveillance : bulletin européen sur les maladies transmissibles</title><addtitle>Euro Surveill</addtitle><description>IntroductionIt is unclear whether high-dose influenza vaccine (HD) is more effective at reducing mortality among seniors.AimThis study aimed to evaluate the relative vaccine effectiveness (rVE) of HD. 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Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10-62) and 25% (95% CI: 12-38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. 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control</subject><subject>Seasons</subject><subject>Survival Analysis</subject><subject>United States - epidemiology</subject><subject>Vaccination - methods</subject><subject>Vaccination - mortality</subject><subject>Veterans - statistics &amp; numerical data</subject><issn>1560-7917</issn><issn>1025-496X</issn><issn>1560-7917</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUU1v2zAMFYoVS9fuLxS67VIn-rAt-7JhKNJ2QIAe0p4F2qITDbYUyGqG7NZ_Xhnpgg4iwA89PpB8hHzjbC4qpha8KFmmaq7my_VcMJHKxZzXyRjLGT8jFyfEpw_xjHwZx98JIlktPpOZFLnkomYX5PXBbraZ8SNS67r-Bd1foHtoW-sgWu8oOEMHHyL0Nh4oDN5t6C6g8UNCuNgf6AA93tA_WxuTG9FZH-geIwZw4w19dqlu6DpCxJQKxsWCSxr9FOZpoSty3kE_4td3f0me75ZPtw_Z6vH-1-3PVdbmOY9ZWWOjqhaVqQoGddNKAGZYUxXSoJQdlMIUHBXHJq0m2lJOD6BsZFmqrpaX5PuRd_fSDGhadDFAr3fBDhAO2oPV__84u9Ubv9dKyErlPBH8OBK0wY9jwO7Uy5me1NHTvfV0b71c60kdLQrNa_2uTmK4_jjCqf-fHPINg7ONUg</recordid><startdate>20200514</startdate><enddate>20200514</enddate><creator>Young-Xu, Yinong</creator><creator>Thornton Snider, Julia</creator><creator>Mahmud, Salaheddin M</creator><creator>Russo, Ellyn M</creator><creator>Van Aalst, Robertus</creator><creator>Thommes, Edward W</creator><creator>Lee, Jason Kh</creator><creator>Chit, Ayman</creator><general>European Centre for Disease Prevention and Control (ECDC)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20200514</creationdate><title>High-dose influenza vaccination and mortality among predominantly male, white, senior veterans, United States, 2012/13 to 2014/15</title><author>Young-Xu, Yinong ; 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MethodsWe linked electronic medical record databases in the Veterans Health Administration (VHA) and Medicare administrative files to examine the rVE of HD vs standard-dose influenza vaccines (SD) in preventing influenza/pneumonia-associated and cardiorespiratory mortality among VHA-enrolled veterans 65 years or older during the 2012/13, 2013/14 and 2014/15 influenza seasons. A multivariable Cox proportional hazards model was performed on matched recipients of HD vs SD, based on vaccination time, location, age, sex, ethnicity and VHA priority level. ResultsAmong 569,552 person-seasons of observation, 207,574 (36%) were HD recipients and 361,978 (64%) were SD recipients, predominantly male (99%) and white (82%). Pooling findings from all three seasons, the adjusted rVE estimate of HD vs SD during the high influenza periods was 42% (95% confidence interval (CI): 24-59) against influenza/pneumonia-associated mortality and 27% (95% CI: 23-32) against cardiorespiratory mortality. Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10-62) and 25% (95% CI: 12-38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. These were confirmed by results from two-stage residual inclusion estimations.DiscussionThe HD was associated with a lower risk of influenza/pneumonia-associated and cardiorespiratory death in men during the high influenza period.</abstract><cop>Sweden</cop><pub>European Centre for Disease Prevention and Control (ECDC)</pub><pmid>32431290</pmid><doi>10.2807/1560-7917.ES.2020.25.19.1900401</doi><oa>free_for_read</oa></addata></record>
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subjects Aged
Aged, 80 and over
Dose-Response Relationship, Drug
Drug-Related Side Effects and Adverse Reactions
Electronic Health Records
European Continental Ancestry Group
Humans
Influenza Vaccines - administration & dosage
Influenza Vaccines - adverse effects
Influenza Vaccines - immunology
Influenza, Human - ethnology
Influenza, Human - mortality
Influenza, Human - prevention & control
Male
Medicare
Pneumonia - ethnology
Pneumonia - mortality
Pneumonia - prevention & control
Seasons
Survival Analysis
United States - epidemiology
Vaccination - methods
Vaccination - mortality
Veterans - statistics & numerical data
title High-dose influenza vaccination and mortality among predominantly male, white, senior veterans, United States, 2012/13 to 2014/15
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