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Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: a population-based cohort study.

Abstract

BACKGROUND

Elderly patients with chronic obstructive pulmonary disease (COPD) are at a higher risk of hospitalization for cardiovascular complications, especially during respiratory infections. Previous studies showed that vaccination for influenza may reduce the risk of recurrent major cardiovascular events in patients with acute coronary syndrome (ACS). The purpose of this study was to evaluate the hypothesis that influenza vaccination could reduce hospitalizations for ACS in elderly patients with COPD.

METHOD

Using the Taiwan Longitudinal Health Insurance Database 1996-2008, this cohort study comprised elderly patients (≥ 55 years old) with a recorded diagnosis of COPD (n=7722) between January 1, 2000 and December 31, 2007. Each patient was followed until the end of 2007. A propensity score was derived by using a logistic regression model to reduce vaccine therapy selection bias. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS in elderly COPD patients was examined by Cox proportional hazards regression analysis. In addition, we categorized the patients into four groups according to vaccination status (unvaccinated, total number of vaccinations: 1, 2-3, and ≥ 4).

RESULTS

We found that elderly patients with COPD receiving influenza vaccination had a lower risk of hospitalization for ACS (adjusted HR=0.46, 95% CI (0.39-0.55), p < 0.001). We observed similar protective effects in both sexes and all age groups (55-64, 65-74, ≥ 75) regardless of influenza seasonality. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for hospitalization because of ACS were 0.48 (0.38-0.62) and 0.20 (0.14-0.28) for patients who received 2-3 and ≥ 4 vaccinations during the follow-up period.

CONCLUSION

Our data showed that there was a lower risk of ACS hospitalization in elderly patients with COPD receiving annual influenza vaccination.

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  • Authors+Show Affiliations

    ,

    Department of Biological Science and Technology, College of Life Sciences, China Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

    ,

    Graduate Institute of Medical Science, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cancer Center, Taipei Medical University - Wan Fang Hospital, Taipei, Taiwan.

    ,

    Cancer Center, Taipei Medical University - Wan Fang Hospital, Taipei, Taiwan; Center of Excellence for Cancer Research, Taipei Medical University, Taipei, Taiwan.

    ,

    Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

    ,

    Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

    ,

    Department of Biological Science and Technology, College of Life Sciences, China Medical University, Taichung, Taiwan.

    ,

    Division of Pediatric Oncology, City of Hope National Medical Center, Duarte, CA United States.

    Department of Biological Science and Technology, College of Life Sciences, China Medical University, Taichung, Taiwan; Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan. Electronic address: liumdcv@tmu.edu.tw.

    Source

    Vaccine 32:30 2014 Jun 24 pg 3843-9

    MeSH

    Aged
    Cohort Studies
    Female
    Follow-Up Studies
    Hospitalization
    Humans
    Influenza Vaccines
    Influenza, Human
    Logistic Models
    Male
    Middle Aged
    Pulmonary Disease, Chronic Obstructive
    Risk Factors
    Taiwan

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    24837769

    Citation

    Sung, Li-Chin, et al. "Influenza Vaccination Reduces Hospitalization for Acute Coronary Syndrome in Elderly Patients With Chronic Obstructive Pulmonary Disease: a Population-based Cohort Study." Vaccine, vol. 32, no. 30, 2014, pp. 3843-9.
    Sung LC, Chen CI, Fang YA, et al. Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: a population-based cohort study. Vaccine. 2014;32(30):3843-9.
    Sung, L. C., Chen, C. I., Fang, Y. A., Lai, C. H., Hsu, Y. P., Cheng, T. H., ... Liu, J. C. (2014). Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: a population-based cohort study. Vaccine, 32(30), pp. 3843-9. doi:10.1016/j.vaccine.2014.04.064.
    Sung LC, et al. Influenza Vaccination Reduces Hospitalization for Acute Coronary Syndrome in Elderly Patients With Chronic Obstructive Pulmonary Disease: a Population-based Cohort Study. Vaccine. 2014 Jun 24;32(30):3843-9. PubMed PMID: 24837769.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: a population-based cohort study. AU - Sung,Li-Chin, AU - Chen,Chang-I, AU - Fang,Yu-Ann, AU - Lai,Chih-Hong, AU - Hsu,Yi-Ping, AU - Cheng,Tzu-Hurng, AU - Miser,James S, AU - Liu,Ju-Chi, Y1 - 2014/05/14/ PY - 2013/12/03/received PY - 2014/03/23/revised PY - 2014/04/21/accepted PY - 2014/5/20/entrez PY - 2014/5/20/pubmed PY - 2014/12/19/medline KW - Acute coronary syndromes KW - Chronic obstructive KW - Cohort studies KW - Influenza vaccines KW - Pulmonary disease SP - 3843 EP - 9 JF - Vaccine JO - Vaccine VL - 32 IS - 30 N2 - BACKGROUND: Elderly patients with chronic obstructive pulmonary disease (COPD) are at a higher risk of hospitalization for cardiovascular complications, especially during respiratory infections. Previous studies showed that vaccination for influenza may reduce the risk of recurrent major cardiovascular events in patients with acute coronary syndrome (ACS). The purpose of this study was to evaluate the hypothesis that influenza vaccination could reduce hospitalizations for ACS in elderly patients with COPD. METHOD: Using the Taiwan Longitudinal Health Insurance Database 1996-2008, this cohort study comprised elderly patients (≥ 55 years old) with a recorded diagnosis of COPD (n=7722) between January 1, 2000 and December 31, 2007. Each patient was followed until the end of 2007. A propensity score was derived by using a logistic regression model to reduce vaccine therapy selection bias. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS in elderly COPD patients was examined by Cox proportional hazards regression analysis. In addition, we categorized the patients into four groups according to vaccination status (unvaccinated, total number of vaccinations: 1, 2-3, and ≥ 4). RESULTS: We found that elderly patients with COPD receiving influenza vaccination had a lower risk of hospitalization for ACS (adjusted HR=0.46, 95% CI (0.39-0.55), p < 0.001). We observed similar protective effects in both sexes and all age groups (55-64, 65-74, ≥ 75) regardless of influenza seasonality. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for hospitalization because of ACS were 0.48 (0.38-0.62) and 0.20 (0.14-0.28) for patients who received 2-3 and ≥ 4 vaccinations during the follow-up period. CONCLUSION: Our data showed that there was a lower risk of ACS hospitalization in elderly patients with COPD receiving annual influenza vaccination. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/24837769/Influenza_vaccination_reduces_hospitalization_for_acute_coronary_syndrome_in_elderly_patients_with_chronic_obstructive_pulmonary_disease:_a_population_based_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(14)00602-1 DB - PRIME DP - Unbound Medicine ER -