PLoS ONE
Volume 13, Issue 11, 2018

Zoster vaccination inequalities: A population based cohort study using linked data from the UK Clinical Practice Research Datalink (Article) (Open Access)

Jain A.* , Walker J.L. , Mathur R. , Forbes H.J. , Langan S.M. , Smeeth L. , Van Hoek A.J. , Thomas S.L.
  • a Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • b Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom, Statistics, Modelling and Economics Department, Public Health England, London, United Kingdom
  • c Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • d Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • e Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • f Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • g Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • h Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

Abstract

Objective To quantify inequalities in zoster vaccine uptake by determining its association with sociodemographic factors: age, gender, ethnicity, immigration status, deprivation (at Lower-layer Super Output Area-level), care home residence and living arrangements. Method This population-based cohort study utilised anonymised primary care electronic health records from England (Clinical Practice Research Datalink) linked to deprivation and hospitalisation data. Data from 35,333 individuals from 277 general practices in England and eligible for zoster vaccination during the two-year period (2013–2015) after vaccine introduction were analysed. Logistic regression was used to obtain adjusted odds ratios (aOR) for the association of socio-demographic factors with zoster vaccine uptake for adults aged 70 years (main target group) and adults aged 79 years (catch-up group). Results Amongst those eligible for vaccination, 52.4% (n = 18,499) received the vaccine. Sociodemographic factors independently associated with lower zoster vaccine uptake in multivariable analyses were: being older (catch-up group: aged 79 years) aOR = 0.89 (95% confidence interval (CI):0.85–0.93), care home residence (aOR = 0.64 (95%CI: 0.57–0.73)) and living alone (aOR = 0.85 (95%CI: 0.81–0.90)). Uptake decreased with increasing levels of deprivation (p-value for trend<0.0001; aOR most deprived versus least deprived areas = 0.69 (95%CI: 0.64–0.75)). Uptake was also lower amongst those of non-White ethnicities (for example, Black versus White ethnicity: aOR = 0.61 (95%CI: 0.49–0.75)) but was not lower among immigrants after adjusting for ethnicity. Lower uptake was also seen amongst females compared to men in the catch-up group. Conclusions Inequalities in zoster vaccine uptake exist in England; with lower uptake among those of non-White ethnicities, and among those living alone, in a care home and in more deprived areas. Tailored interventions to increase uptake in these social groups should assist in real-ising the aim of mitigating vaccination inequalities. As care home residents are also at higher risk of zoster, improving the uptake of zoster vaccination in this group will also mitigate inequalities in zoster burden. © 2018 Jain et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Author Keywords

[No Keywords available]

Index Keywords

human immigration sex difference Cohort Studies nursing home patient Aged cohabitation marriage immunosuppressive treatment treatment duration Humans male England patient risk female Socioeconomic Factors varicella zoster vaccine risk factor Risk Factors drug uptake socioeconomics Herpes Zoster Vaccine Article major clinical study age cohort analysis ethnicity vaccination disease burden Healthcare Disparities health care disparity herpes zoster primary health care
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85056540938&doi=10.1371%2fjournal.pone.0207183&partnerID=40&md5=588d7b7ce86af8a50eb3d59efe3eec26
DOI: 10.1371/journal.pone.0207183
ISSN: 19326203
Original Language: English