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.
Original language | English |
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Article number | e0207183 |
Journal | PLoS ONE |
Volume | 13 |
Issue number | 11 |
DOIs | |
Publication status | Published - Nov 2018 |
Bibliographical note
Funding Information:This research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (PHE). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or PHE. AJ’s PhD studentship was funded by National Institute for Health Research (HPRU-2012-10096). JLW has received grants from National Institute for Health Research (HPRU-2012-10096). RM is supported by a Sir Henry Wellcome Postdoctoral Fellowship from the Wellcome Trust [201375/Z/16/Z]. HJF has nothing to disclose. SML reports grants from National Institute for Health Research and from Wellcome Senior Clinical Fellowship in Science. LS reports grants from Wellcome Trust (098504/Z/12/ Z), grants from MRC, grants from NIHR, grants and personal fees from GSK, personal fees from AstraZeneca, grants from European Union, and is a trustee of the British Heart Foundation. AJVH has received grants from National Institute for Health Research (HPRU-2012-10096). SLT has received grants from National Institute for Health Research (HPRU-2012-10096).
Publisher Copyright:
© 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.