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Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes.
CMAJ 2016; 188(14):E342-E351CMAJ

Abstract

BACKGROUND

The health burden caused by seasonal influenza is substantial. We sought to examine the effectiveness of influenza vaccination against admission to hospital for acute cardiovascular and respiratory conditions and all-cause death in people with type 2 diabetes.

METHODS

We conducted a retrospective cohort study using primary and secondary care data from the Clinical Practice Research Datalink in England, over a 7-year period between 2003/04 and 2009/10. We enrolled 124 503 adults with type 2 diabetes. Outcome measures included admission to hospital for acute myocardial infarction (MI), stroke, heart failure or pneumonia/influenza, and death. We fitted Poisson regression models for influenza and off-season periods to estimate incidence rate ratios (IRR) for cohorts who had and had not received the vaccine. We used estimates for the summer, when influenza activity is low, to adjust for residual confounding.

RESULTS

Study participants contributed to 623 591 person-years of observation during the 7-year study period. Vaccine recipients were older and had more comorbid conditions compared with nonrecipients. After we adjusted for covariates and residual confounding, vaccination was associated with significantly lower admission rates for stroke (IRR 0.70, 95% confidence interval [CI] 0.53-0.91), heart failure (IRR 0.78, 95% CI 0.65-0.92) and pneumonia or influenza (IRR 0.85, 95% CI 0.74-0.99), as well as all-cause death (IRR 0.76, 95% CI 0.65-0.83), and a nonsignificant change for acute MI (IRR 0.81, 95% CI 0.62-1.04) during the influenza seasons.

INTERPRETATION

In this cohort of patients with type 2 diabetes, influenza vaccination was associated with reductions in rates of admission to hospital for specific cardiovascular events. Efforts should be focused on improvements in vaccine uptake in this important target group as part of comprehensive secondary prevention.

Authors+Show Affiliations

Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust e.vamos@imperial.ac.uk.Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27455981

Citation

Vamos, Eszter P., et al. "Effectiveness of the Influenza Vaccine in Preventing Admission to Hospital and Death in People With Type 2 Diabetes." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 188, no. 14, 2016, pp. E342-E351.
Vamos EP, Pape UJ, Curcin V, et al. Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ. 2016;188(14):E342-E351.
Vamos, E. P., Pape, U. J., Curcin, V., Harris, M. J., Valabhji, J., Majeed, A., & Millett, C. (2016). Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 188(14), pp. E342-E351. doi:10.1503/cmaj.151059.
Vamos EP, et al. Effectiveness of the Influenza Vaccine in Preventing Admission to Hospital and Death in People With Type 2 Diabetes. CMAJ. 2016 Oct 4;188(14):E342-E351. PubMed PMID: 27455981.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes. AU - Vamos,Eszter P, AU - Pape,Utz J, AU - Curcin,Vasa, AU - Harris,Matthew J, AU - Valabhji,Jonathan, AU - Majeed,Azeem, AU - Millett,Christopher, Y1 - 2016/07/25/ PY - 2016/05/02/accepted PY - 2016/7/28/pubmed PY - 2017/4/4/medline PY - 2016/7/27/entrez SP - E342 EP - E351 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 188 IS - 14 N2 - BACKGROUND: The health burden caused by seasonal influenza is substantial. We sought to examine the effectiveness of influenza vaccination against admission to hospital for acute cardiovascular and respiratory conditions and all-cause death in people with type 2 diabetes. METHODS: We conducted a retrospective cohort study using primary and secondary care data from the Clinical Practice Research Datalink in England, over a 7-year period between 2003/04 and 2009/10. We enrolled 124 503 adults with type 2 diabetes. Outcome measures included admission to hospital for acute myocardial infarction (MI), stroke, heart failure or pneumonia/influenza, and death. We fitted Poisson regression models for influenza and off-season periods to estimate incidence rate ratios (IRR) for cohorts who had and had not received the vaccine. We used estimates for the summer, when influenza activity is low, to adjust for residual confounding. RESULTS: Study participants contributed to 623 591 person-years of observation during the 7-year study period. Vaccine recipients were older and had more comorbid conditions compared with nonrecipients. After we adjusted for covariates and residual confounding, vaccination was associated with significantly lower admission rates for stroke (IRR 0.70, 95% confidence interval [CI] 0.53-0.91), heart failure (IRR 0.78, 95% CI 0.65-0.92) and pneumonia or influenza (IRR 0.85, 95% CI 0.74-0.99), as well as all-cause death (IRR 0.76, 95% CI 0.65-0.83), and a nonsignificant change for acute MI (IRR 0.81, 95% CI 0.62-1.04) during the influenza seasons. INTERPRETATION: In this cohort of patients with type 2 diabetes, influenza vaccination was associated with reductions in rates of admission to hospital for specific cardiovascular events. Efforts should be focused on improvements in vaccine uptake in this important target group as part of comprehensive secondary prevention. SN - 1488-2329 UR - https://www.unboundmedicine.com/medline/citation/27455981/Effectiveness_of_the_influenza_vaccine_in_preventing_admission_to_hospital_and_death_in_people_with_type_2_diabetes_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=27455981 DB - PRIME DP - Unbound Medicine ER -