Effectiveness of influenza vaccination in elderly diabetic patients: A retrospective cohort study

doi:10.1016/j.vaccine.2012.11.017

Vaccine

Volume 31, Issue 4, 11 January 2013, Pages 718-724

https://doi.org/10.1016/j.vaccine.2012.11.017 Get rights and content

Abstract

Purpose

Studies regarding the clinical benefits of influenza vaccination in diabetic patients are limited. This study evaluated if the elderly diabetic patients who have had influenza vaccination would have benefits such as reduced medical care and mortality.

Methods

We used the universal insurance claims data from 2001 to 2009 in Taiwan to identify annual elderly patients with diabetes cohorts with (N = 4454) and without (N = 4571) influenza vaccination. The risk of developing pneumonia or influenza, respiratory failure, intensive care, hospitalization, and mortality were measured and compared between cohorts within one year of follow-up.

Results

The vaccine cohort had lower incidences of pneumonia or influenza and respiratory failure compared with the non-vaccine cohort. More importantly, the vaccine cohort had a hospitalization rate that was 11% less than the non-vaccine cohort (29.6 vs. 33.1 per 100 person-years) with an adjusted hazard ratio (HR) of 0.88 (95% CI 0.81–0.96). The vaccine cohort was also less likely to be admitted to the intensive care unit (ICU) [0.58 vs. 2.05 per 100 person-year; adjusted HR 0.30 (95% CI 0.19–0.47)] and less likely to expire [3.13 vs. 7.96 per 100 person-year; adjusted HR 0.44 (95% CI 0.36–0.54)]. Influenza vaccination reduced the hospitalization cost by 1282.6 USD, compared with patients without influenza vaccination (95% CI −2210.3, −354.8).

Conclusion

Influenza vaccination is associated with a reduced risk of morbidity, hospitalization, ICU admissions, and mortality. In addition, the hospitalization cost is reduced.

Highlights

► We used the universal insurance claims data from 2001 to 2009 in Taiwan. ► The elderly diabetic patients with and without influenza vaccination were identified. ► Influenza vaccination is associated with a reduced risk of morbidity, and mortality. ► In addition, the hospitalization cost is less.

Introduction

The influenza virus, which is a common transmissible human respiratory virus, is a major cause of illness and death. In the Unites States, influenza resulted in more than 225,000 hospitalizations and 36,000 deaths annually [1], [2]. The morbidity and mortality of influenza is high among the elderly, pregnant women, immunocompromised hosts, and those with chronic diseases such as diabetes mellitus (DM) [3]. DM is a serious and growing health problem worldwide. A total of 439 million adults are estimated to be affected with DM by 2030 with a 20% increase in developed countries and 69% increase in developing countries from 2010 to 2030 [4]. Abnormal glucose metabolism has been associated with the dysfunction of leukocytes, such as phagocytosis, chemotaxis, and leukocyte adherence [5]. Therefore, diabetic patients have a high morbidity and mortality from infection [6]. These patients are susceptible to influenza and pneumonia [7], [8]. In addition, diabetic patients were reported to be two to four times more likely to die from influenza and pneumonia compared with people without diabetes [9].

Due to ethical considerations, performing randomized controlled trials for influenza vaccination is difficult. Observation studies have found that influenza vaccination can reduce the risk of hospitalizations and deaths in elderly and high-risk individuals [10], [11]. However, studies on the clinical benefits of such a vaccination for DM patients are limited [11], [12], [13], [14]. The aim of this study is to evaluate the efficacy of influenza vaccination in reducing morbidity and mortality in newly diagnosed elderly DM patients using a population-based cohort study.

Section snippets

Data sources

This study used a subset of claims data from the National Health Research Institutes Database (NHID) obtained from Taiwan's National Health Insurance program. The National Health Insurance system in Taiwan is a universal insurance program established by the Bureau of National Health Insurance. The insurance program started in March 1995 and has now covered approximately 99% of the 23.74 million residents in Taiwan [15]. This subset data included claims data from 2001 to 2009 that were randomly

Results

In Taiwan, the prevalence of diabetes patients in the elderly increased from 19.4% in 2001 to a peak of 24.6% in 2009 (data not shown). The study subjects were composed of 4571 newly diagnosed diabetic patients with influenza vaccination in the vaccine cohort and 4454 newly diagnosed diabetic patients without influenza vaccination in the non-vaccine cohort. The mean ages of the two cohorts were not statistically different, but the vaccine cohort had lesser subjects aged 75 years, 32.2% vs.

Discussion

Influenza vaccination for elderly patients that are newly diagnosed with DM was associated with lower subsequent morbidities even when they had been more prevalent with co-morbidities at the baseline. In addition, influenza vaccination was associated with a lower all-cause mortality risk of 56%. The hospitalization rate was reduced for 11% with lower hospitalization cost and shortened hospitalization length (data not shown). Our further analysis also revealed that the other health care costs

Acknowledgements

The authors would like to thank the National Health Research Institute in Taiwan for providing the insurance claims data. This study was supported partly by the National Sciences Council, Executive Yuan (Grant Number NSC 100-2621-M-039-001), China Medical University Hospital (Grant Number 1MS1), and Taiwan Department of Health Clinical Trial and Research Center for Excellence (Grant Numbers DOH101-TD-B-111-004 and DOH101-TD-C111-005).

Conflict of interest: The authors declare no conflicts of

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Influenza: Diabetes as a risk factor for severe related-outcomes and the effectiveness of vaccination in diabetic population. A meta-analysis of observational studies
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In order to better define the need for influenza vaccination in people with diabetes (DM), we collected all available evidence on the effect of DM as a risk factor for complications of both seasonal and pandemic influenza, and on the specific effectiveness of vaccines in patients with DM.
Two distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and Embase databases were performed, one for each metanalysis, collecting all observational studies and randomized clinical trials performed on humans up to May 31st, 2022. We retrieved 34 observational studies comparing risk for influenza complications in people with or without diabetes, and 13 observational studies assessing vaccine effectiveness on preventing such complications. Mortality for influenza and hospitalization for influenza and pneumonia resulted significantly higher in individuals with versus without DM, both when unadjusted and adjusted data are analyzed. In diabetic individuals vaccinated for influenza overall hospitalization, hospitalization for influenza or pneumonia and overall mortality are significantly lower in comparison with not vaccinated DM subjects, both when unadjusted and adjusted data were analyzed.
This systematic review and meta-analysis shows that: 1) influenza is associated with more severe complications in diabetic versus not diabetic individuals and 2) influenza vaccination is effective in preventing clinically relevant outcomes in adults with DM with a NNT (number needed to treat) of 60, 319, and 250 for all-cause hospitalization, specific hospitalization, and all-cause mortality, respectively. The identification of diabetic patients as the target of vaccination campaigns for influenza appears to be justified by available clinical evidence.
Outcomes following diabetes admission in patients who had influenza vaccination: A population-based cohort study
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Citation Excerpt :
Our findings further support the Standards of Care 2019 guidelines published by the American Diabetes Association that recommend IV for all patients with diabetes [37]. Some studies have shown that IV was beneficial to patients with diabetes in decreasing the risk of hospitalization, morbidity and mortality [15–20,22]. Nevertheless, in patients with poor glycemic control and/or those who have diabetes-related complications, a more dysfunctional immune response and lower functional reserve of organ systems would be expected [32].
The beneficial effect of influenza vaccination (IV) in patients with diabetes was not completely understood.
Using the research data of health insurance, we performed a cohort study of patients aged ≥20 years who were admitted to inpatient care due to diabetes in 2008–2013 in Taiwan. We performed the propensity score matching and the outcomes of complications and mortality following the diabetes admission was compared between patients with and without IV.
Among 61,002 patients with diabetes admission, IV reduced 30-day in-hospital mortality (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.66–0.84), particularly among patients with prior diabetes hospitalization, inadequate control for diabetes, and diabetes-related comorbidities, such as eye involvement, ketoacidosis, renal manifestations, and coma. Compared with non-IV control group, patients with IV also had decreased risks of pneumonia (OR 0.92, 95% CI 0.87–0.97), septicemia (OR 0.83, 95% CI 0.79–0.88), urinary tract infection (OR 0.94, 95% CI 0.90–0.97), and intensive care (OR 0.29, 95% CI 0.27–0.31).
In patients with diabetes admission, IV was associated with reduced risks of complications and mortality. Our study implicated the urgent need to promote influenza vaccination for this susceptible population with diabetes.
Burden and disease pathogenesis of influenza and other respiratory viruses in diabetic patients
2022, Journal of Infection and Public Health
Over the past two decades, diabetes mellitus (DM) has been receiving increasing attention among autoimmune diseases. The prevalence of type 1 and type 2 diabetes has increased rapidly and has become one of the leading causes of death worldwide. Therefore, a better understanding of the genetic and environmental risk factors that trigger the onset of DM would help develop more efficient therapeutics and preventive measures. The role and mechanism of respiratory viruses in inducing autoimmunity have been frequently reported. On the other hand, the association of DM with respiratory infections might result in severe complications or even death. Since influenza is the most common respiratory infection, DM patients experience disease severity and increased hospitalization during influenza season. Vaccinating diabetic patients against influenza would significantly reduce hospitalization due to disease severity. However, recent studies also report the role of viral vaccines in inducing autoimmunity, specifically diabetes. This review reports causes of diabetes, including genetic and viral factors, with a special focus on respiratory viruses. We further brief the burden of influenza-associated complications and the effectiveness of the influenza vaccine in DM patients.
Current Vaccination Practice in Diabetic (Diabetes I) Patients
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Review of Vaccination Recommendations in Guidelines for Non-Communicable Diseases with Highest Global Disease Burden among Adults 75 Years Old and Above
2023, Vaccines
COVID-19-related fear and anxiety in a sample of patients with type 2 diabetes: a cross-sectional study in Iran after several peaks of the pandemic
2023, Journal of Diabetes and Metabolic Disorders

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Effectiveness of influenza vaccination in elderly diabetic patients: A retrospective cohort study

Abstract

Purpose

Methods

Results

Conclusion

Highlights

Introduction

Section snippets

Data sources

Results

Discussion

Acknowledgements

Influenza-associated hospitalizations in the United States

J Am Med Assoc

Mortality associated with influenza and respiratory syncytial virus in the United States

J Am Med Assoc

Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010

MMWR Recomm Rep

Global estimates of the prevalence of diabetes for 2010 and 2030

Diabetes Res Clin Pract

Impaired leucocyte functions in diabetic patients

Diabet Med

Diabetes and the risk of infection-related mortality in the U.S.

Diabetes Care

Effect of epidemic influenza on ketoacidosis, pneumonia and death in diabetes mellitus: a hospital register survey of 1976-1979 in The Netherlands

Diabetes Res Clin Pract

Pulmonary complications of diabetes mellitus. Pneumonia

Infect Dis Clin North Am

Impact of diabetes mellitus on mortality associated with pneumonia and influenza among non-Hispanic black and white US adults

Am J Public Health

Clinical effectiveness of influenza vaccination in persons younger than 65 years with high-risk medical conditions: the PRISMA study

Arch Intern Med

Influence of high-risk medical conditions on the effectiveness of influenza vaccination among elderly members of 3 large managed-care organizations

Clin Infect Dis

Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes

Epidemiol Infect

Reduced hospitalizations and death associated with influenza vaccination among patients with and without diabetes

Diabetes Care

Clinical effectiveness of first and repeat influenza vaccination in adult and elderly diabetic patients

Diabetes Care