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Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: A Population-Based Cohort Study.
Medicine (Baltimore). 2016 Mar; 95(9):e2868.M

Abstract

Taiwan has the highest prevalence of chronic kidney disease (CKD) worldwide. CKD, a manifestation of vascular diseases, is associated with a high risk of dementia. Here, we estimated the association between influenza vaccination and dementia risk in patients with CKD. Data from the National Health Insurance Research Database of Taiwan were used in this study. The study cohort included all patients diagnosed with CKD (according to International Classification of Disease, Ninth Revision, Clinical Modification codes) at healthcare facilities in Taiwan (n = 32,844) from January 1, 2000, to December 31, 2007. Each patient was followed up to assess dementia risk or protective factors: demographic characteristics of age and sex; comorbidities of diabetes, hypertension, dyslipidemia, cerebrovascular diseases, parkinsonism, epilepsy, substance and alcohol use disorders, mood disorder, anxiety disorder, psychotic disorder, and sleep disorder; urbanization level; monthly income; and statin, metformin, aspirin, and angiotensin-converting enzyme inhibitor (ACEI) use. A propensity score was derived using a logistic regression model for estimating the effect of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) of dementia among vaccinated and unvaccinated CKD patients. The study population comprised 11,943 eligible patients with CKD; 5745 (48%) received influenza vaccination and the remaining 6198 (52%) did not. The adjusted HRs (aHRs) of dementia decreased in vaccinated patients compared with those in unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.68, 0.58, and 0.64; P < 0.0001, P < 0.0001, and P < 0.0001, respectively). In the sensitivity analysis, adjustments were made to estimate the association of age and sex; diabetes, dyslipidemia, hypertension, cerebrovascular diseases, anxiety disorder; and statin, metformin, ACEI, and aspirin use with the incidence of dementia in various models. A stronger protective effect against dementia risk was demonstrated during the noninfluenza season. Regardless of comorbidities or drug use, influenza vaccination was an independent protective factor and dose-dependently reduced the risk of dementia in CKD patients. Influenza vaccination exerts dose-response and synergistic protective effects against dementia in CKD patients with dementia risk factors by reducing the incidence of dementia.

Authors+Show Affiliations

From the Division of Cardiovascular Medicine (J-CL, Y-PH, P-FK, W-RH, C-FL, L-CS), Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City; Institute of Toxicology (S-HL, S-YW), College of Medicine, National Taiwan University; Department of Radiation Oncology (S-YW), Wan Fang Hospital; Department of Internal Medicine (J-CL, P-FK, S-YW), School of Medicine, College of Medicine, Taipei Medical University, Taipei; and Department of Biotechnology (S-YW), Hungkuang University, Taichung, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26945371

Citation

Liu, Ju-Chi, et al. "Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: a Population-Based Cohort Study." Medicine, vol. 95, no. 9, 2016, pp. e2868.
Liu JC, Hsu YP, Kao PF, et al. Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: A Population-Based Cohort Study. Medicine (Baltimore). 2016;95(9):e2868.
Liu, J. C., Hsu, Y. P., Kao, P. F., Hao, W. R., Liu, S. H., Lin, C. F., Sung, L. C., & Wu, S. Y. (2016). Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: A Population-Based Cohort Study. Medicine, 95(9), e2868. https://doi.org/10.1097/MD.0000000000002868
Liu JC, et al. Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: a Population-Based Cohort Study. Medicine (Baltimore). 2016;95(9):e2868. PubMed PMID: 26945371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influenza Vaccination Reduces Dementia Risk in Chronic Kidney Disease Patients: A Population-Based Cohort Study. AU - Liu,Ju-Chi, AU - Hsu,Yi-Ping, AU - Kao,Pai-Feng, AU - Hao,Wen-Rui, AU - Liu,Shing-Hwa, AU - Lin,Chao-Feng, AU - Sung,Li-Chin, AU - Wu,Szu-Yuan, PY - 2016/3/6/entrez PY - 2016/3/6/pubmed PY - 2016/8/10/medline SP - e2868 EP - e2868 JF - Medicine JO - Medicine (Baltimore) VL - 95 IS - 9 N2 - Taiwan has the highest prevalence of chronic kidney disease (CKD) worldwide. CKD, a manifestation of vascular diseases, is associated with a high risk of dementia. Here, we estimated the association between influenza vaccination and dementia risk in patients with CKD. Data from the National Health Insurance Research Database of Taiwan were used in this study. The study cohort included all patients diagnosed with CKD (according to International Classification of Disease, Ninth Revision, Clinical Modification codes) at healthcare facilities in Taiwan (n = 32,844) from January 1, 2000, to December 31, 2007. Each patient was followed up to assess dementia risk or protective factors: demographic characteristics of age and sex; comorbidities of diabetes, hypertension, dyslipidemia, cerebrovascular diseases, parkinsonism, epilepsy, substance and alcohol use disorders, mood disorder, anxiety disorder, psychotic disorder, and sleep disorder; urbanization level; monthly income; and statin, metformin, aspirin, and angiotensin-converting enzyme inhibitor (ACEI) use. A propensity score was derived using a logistic regression model for estimating the effect of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) of dementia among vaccinated and unvaccinated CKD patients. The study population comprised 11,943 eligible patients with CKD; 5745 (48%) received influenza vaccination and the remaining 6198 (52%) did not. The adjusted HRs (aHRs) of dementia decreased in vaccinated patients compared with those in unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs = 0.68, 0.58, and 0.64; P < 0.0001, P < 0.0001, and P < 0.0001, respectively). In the sensitivity analysis, adjustments were made to estimate the association of age and sex; diabetes, dyslipidemia, hypertension, cerebrovascular diseases, anxiety disorder; and statin, metformin, ACEI, and aspirin use with the incidence of dementia in various models. A stronger protective effect against dementia risk was demonstrated during the noninfluenza season. Regardless of comorbidities or drug use, influenza vaccination was an independent protective factor and dose-dependently reduced the risk of dementia in CKD patients. Influenza vaccination exerts dose-response and synergistic protective effects against dementia in CKD patients with dementia risk factors by reducing the incidence of dementia. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/26945371/Influenza_Vaccination_Reduces_Dementia_Risk_in_Chronic_Kidney_Disease_Patients:_A_Population_Based_Cohort_Study_ L2 - http://dx.doi.org/10.1097/MD.0000000000002868 DB - PRIME DP - Unbound Medicine ER -