Influenza and pneumococcal vaccine receipt in older persons with chronic disease - A population-based study

OBJECTIVE. TO identify factors associated with receipt of the pneumococcal and influenza vaccines among community-dwelling older persons with chronic disease. METHODS. A population-based sample of urban and rural Iowa adults age 65 ye ars and older with one or more self-reported target medical conditions were interviewed by telephone. Information was obtained on aspects of health ca re access, which were examined as potential determinants of receipt of reco mmended vaccines. RESULTS. A total of 787 interviews were completed (response rate = 68%; com pletion rate for screened, eligible subjects = 91%). Two-thirds (n = 531, 6 8%) reported influenza vaccination in the last year, and one-half (51%, n = 393) reported ever receiving the pneumococcal vaccine. Both vaccines were received at recommended intervals by 347 subjects (44%). Multivariable logi stic regression identified the following factors independently associated w ith receipt of both vaccines: age 70 or greater (OR = 1.64, CI95 = 1.15, 2. 32); married (OR = 1.41, CI95 = 1.03, 1.92); self-owned residence (OR = 0.5 7, CI95 = 0.33, 0.97); working (OR = 2.94, CI95 = 1.38, 6.18); increased nu mber of target medical conditions (OR = 1.3 for each, CI95 = 1.09, 1.54); c urrent prescription medication (OR 2.04, CI95 = 1.32, 3.14); and a physicia n visit in the last year (OR = 2.53, CI95 = 1.52-4.19). Receipt of the vacc ines was unrelated to geographic location in a rural area. CONCLUSIONS. Despite their proven safety and efficacy, many persons with at least two indications to receive either vaccine remain unvaccinated. Among the elderly with chronic disease, predisposing and need factors were indep endently associated with receipt of both vaccines. Enabling factors assesse d appeared less important in this population. Targeting of the elderly and those with chronic disease to receive recommended vaccines is needed to ade quately protect these populations at risk.