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The Effect of Influenza Vaccination for the Elderly on Hospitalization and Mortality: An Observational Study With a Regression Discontinuity Design.
Annals of Internal Medicine ( IF 39.2 ) Pub Date : 2020-03-03 , DOI: 10.7326/m19-3075
Michael L Anderson 1 , Carlos Dobkin 2 , Devon Gorry 3
Affiliation  

Background Observational studies using traditional research designs suggest that influenza vaccination reduces hospitalizations and mortality among elderly persons. Accordingly, health authorities in some countries prioritize vaccination of this population. Nevertheless, questions remain about this policy's effectiveness given the potential for bias and confounding in observational data. Objective To determine the effectiveness of the influenza vaccine in reducing hospitalizations and mortality among elderly persons by using an observational research design that reduces the possibility of bias and confounding. Design A regression discontinuity design was applied to the sharp change in vaccination rate at age 65 years that resulted from an age-based vaccination policy in the United Kingdom. In this design, comparisons were limited to individuals who were near the age-65 threshold and were thus plausibly similar along most dimensions except vaccination rate. Setting England and Wales. Participants Adults aged 55 to 75 years residing in the study area during 2000 to 2014. Intervention Seasonal influenza vaccine. Measurements Hospitalization and mortality rates by month of age. Results The data included 170 million episodes of care and 7.6 million deaths. Turning 65 was associated with a statistically and clinically significant increase in rate of seasonal influenza vaccination. However, no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons. The estimates were precise enough to rule out results from many previous studies. Limitation The study relied on observational data, and its focus was limited to individuals near age 65 years. Conclusion Current vaccination strategies prioritizing elderly persons may be less effective than believed at reducing serious morbidity and mortality in this population, which suggests that supplementary strategies may be necessary. Primary Funding Source National Institute on Aging.

中文翻译:

老年人流感疫苗接种对住院和死亡率的影响:带有回归间断设计的观察性研究。

背景技术使用传统研究设计进行的观察性研究表明,接种流感疫苗可降低老年人的住院率和死亡率。因此,一些国家的卫生当局优先对该人群进行疫苗接种。然而,鉴于观测数据可能存在偏差和混淆,因此对该政策的有效性仍然存在疑问。目的通过观察研究设计确定流感疫苗在降低老年人住院和死亡率方面的有效性,该研究设计可减少偏见和混淆的可能性。设计回归不连续性设计适用于英国基于年龄的疫苗接种政策导致的65岁时接种率的急剧变化。在这个设计中 比较仅限于接近65岁年龄段的个体,因此除疫苗接种率外,在大多数方面似乎相似。设置英格兰和威尔士。参与者2000年至2014年期间居住在研究区的55至75岁的成年人。干预季节性流感疫苗。测量按月龄计算的住院率和死亡率。结果数据包括1.7亿例护理事件和760万例死亡。65岁时,季节性流感疫苗接种率在统计上和临床上均显着增加。但是,没有证据表明接种疫苗可以降低老年人的住院率或死亡率。估计值足够精确,可以排除许多先前研究的结果。局限性该研究依赖于观察数据,并且其关注重点仅限于65岁左右的人群。结论当前优先考虑老年人的疫苗接种策略在降低该人群的严重发病率和死亡率方面可能不如人们认为的有效,这表明补充策略可能是必要的。国家老龄研究所的主要资金来源。
更新日期:2020-03-03
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