Influenza-associated hospitalisation, vaccine uptake and socioeconomic deprivation in an English city region: An ecological study

Daniel Hungerford*, Ana Ibarz-Pavon, Paul Cleary, Neil French

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Objectives Every year, influenza poses a significant burden on the National Health Service in England. Influenza vaccination is an effective measure to prevent severe disease, hence, maximising vaccine coverage in the most vulnerable is a priority. We aimed to identify the extent to which socioeconomic status is associated with influenza-associated illness (IAI) and influenza vaccine coverage. Design Retrospective observational study using hospital episode statistics. Setting Merseyside, North-West of England, including the city of Liverpool. Participants Residents of Merseyside hospitalised with IAI between April 2004 and March 2016, and Merseyside general practice registered patients eligible for influenza vaccination in 2014/2015 and 2015/2016 influenza seasons. Exposures Socioeconomic deprivation based on lower super output area English Indices of Deprivation scores. Primary and secondary outcome measures Incidence and risk of IAI hospitalisation, and vaccine uptake. Results There were 89 058 hospitalisations related to IAI among Merseyside residents (mean yearly rate=4.9 per 1000 population). Hospitalisations for IAI were more frequent in the most socioeconomically deprived areas compared with the least deprived in adults aged 15-39 years (incidence rate ratio (IRR) 2.08;95% CI 1.76 to 2.45; p<0.001), 60-64 years (IRR 2.65; 95% CI 2.35 to 2.99; p<0.001) and 65+ years (IRR 1.90; 95% CI 1.73 to 2.10; p<0.001), whereas rates in children were more homogeneous across deprivation strata. Vaccine uptake was lower than the nationally set targets in most neighbourhoods. The odds of vaccine uptake were 30% lower (OR 0.70; 95% CI 0.66 to 0.74; p<0.001) and 10% lower (OR 0.90; 95% CI 0.88 to 0.92; p<0.001) in the most socioeconomically deprived quintile compared with the least deprived, among children aged 24-59 months and 65+ years, respectively. Conclusions Higher rates of IAI hospitalisations and lower vaccine uptake in the most socioeconomically deprived populations suggest that health promotion policies and interventions that target these populations should be a priority.

Original languageEnglish
Article numbere023275
JournalBMJ Open
Issue number12
Publication statusPublished - 1 Dec 2018

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© Author(s) (or their employer(s)) 2018.


  • ecological
  • epidemiology
  • inequalities
  • influenza
  • public health
  • vaccination


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