RATIONALE & OBJECTIVE Influenza vaccination is recommended for all adults but particularly for older adults and those with high-risk conditions. Reduced kidney function is an important high-risk condition, but the effectiveness of influenza vaccination across kidney function is uncharacterized. We assessed the effectiveness of influenza vaccination among older adults with and without reduced kidney function. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 454,634 person-seasons among 110,968 individuals 65 years or older in the Geisinger Health System between the 2005 and 2015 influenza seasons, with baseline characteristics matched between those with and without vaccination using inverse probability weighting. EXPOSURES Status of influenza vaccination. OUTCOMES Incident hospitalization with pneumonia/influenza, coronary heart disease, and heart failure during influenza season stratified by estimated glomerular filtration rate (eGFR; ≥ 60, 30-59, and < 30mL/min/1.73m2). ANALYTICAL APPROACH Pooled logistic regression analysis to estimate adjusted ORs. RESULTS In the 2014-2015 influenza season, the prevalence of influenza vaccination was 63.3% without evident difference across eGFR categories. The incidence of hospitalization was higher in lower eGFRs (eg, 2.2% per person-season among those not vaccinated with eGFR < 30 vs 0.7% with ≥ 60mL/min/1.73m2 for pneumonia/influenza). Overall, influenza vaccination was associated with lower odds of hospitalization with pneumonia/influenza (OR, 0.86; 95% CI, 0.79-0.93), coronary heart disease (OR, 0.93; 95% CI, 0.88-0.97), and heart failure (OR, 0.92; 95% CI, 0.86-0.99). When assessing by eGFR categories, the association was consistent in eGFR ≥ 30, but not significant in < 30mL/min/1.73m2 (ORs of 1.04 [95% CI, 0.79-1.36] for pneumonia/influenza, 1.03 [95% CI, 0.87-1.23] for coronary heart disease, and 1.10 [95% CI, 0.92-1.33] for heart failure). LIMITATIONS Possible unmeasured confounding. CONCLUSIONS Influenza vaccination was associated with lower risk for hospitalizations with pneumonia/influenza and major cardiac diseases in eGFR ≥ 30mL/min/1.73m2. Studies are needed to explore optimal vaccination strategies for eGFR < 30mL/min/1.73m2.

中文翻译：

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跨肾脏功能的老年人中流感疫苗接种的有效性：2005-2006年至2014-2015年流感季节的汇总分析。

理由和目标建议所有成年人都接种流感疫苗，特别是对老年人和高危人群。肾功能下降是一种重要的高危疾病，但跨肾功能进行流感疫苗接种的效果尚无定论。我们评估了在有和没有肾功能降低的老年人中进行流感疫苗接种的有效性。研究设计观察性队列研究。背景与参与者在2005年至2015年流感季节之间，Geisinger卫生系统的65,65岁及65岁以上的110,968名个体中的454,634人/季节，其基线特征在使用和未使用疫苗的人群之间使用逆概率加权进行了匹配。暴露流感疫苗接种情况。结果因肺炎/流行性感冒而住院治疗，冠心病和流感季节期间的心力衰竭按估计的肾小球滤过率进行分层（eGFR；≥60、30-59和<30mL / min / 1.73m2）。分析方法汇总逻辑回归分析以估计调整后的OR。结果在2014-2015年流感季节，流感疫苗接种率是63.3％，不同eGFR类别之间没有明显差异。较低的eGFRs的住院率较高（例如，未接种eGFR <30的人中，每人每季2.2％，而≥60mL / min / 1.73m2的肺炎/流感患者为0.7％）。总体而言，接种流感疫苗与肺炎/流感（OR，0.86; 95％CI，0.79-0.93），冠心病（OR，0.93; 95％CI，0.88-0.97）的住院几率降低相关（ OR，0.92； 95％CI，0.86-0.99）。在按eGFR类别进行评估时，eGFR≥30时相关性一致，但在<30mL / min / 1.73m2中则无显着性（肺炎/流感的ORs为1.04 [95％CI，0.79-1.36]，冠状动脉的ORs为1.03 [95％CI，0.87-1.23]心脏病和1.10 [95％CI，0.92-1.33]（心力衰竭））。局限性可能造成无法估量的混淆。结论eGFR≥30mL / min / 1.73m2时，流感疫苗接种与住院肺炎/流感和重大心脏病的风险较低有关。需要进行研究以探索eGFR <30mL / min / 1.73m2的最佳疫苗接种策略。结论在eGFR≥30mL / min / 1.73m2中，流感疫苗接种与住院肺炎/流感和重大心脏病的风险较低有关。需要进行研究以探索eGFR <30mL / min / 1.73m2的最佳疫苗接种策略。结论eGFR≥30mL / min / 1.73m2时，流感疫苗接种与住院肺炎/流感和重大心脏病的风险较低有关。需要进行研究以探索eGFR <30mL / min / 1.73m2的最佳疫苗接种策略。