Influenza vaccination trend and related factors among patients with diabetes in Korea: Analysis using a nationwide database

Abstract

BackgroundSubjects with diabetes are at higher risk of serious influenza-related complications. We aimed to investigate the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza in subjects with diabetes using a nationwide observational study performed within the recent decade.MethodsAmong 105,732 subjects from the Korea National Health and Nutrition Examination Survey between 2007 and 2019, 8,632 with diabetes were included. We investigated the yearly trend of influenza vaccination and factors associated with being unvaccinated for influenza.ResultsDuring the study period, the prevalence of influenza vaccination in subjects with diabetes showed a tendency to increase every year, reaching almost 60% in 2019, which was higher than the rate in subjects without diabetes. Younger age (adjusted hazard ratio (aHR) [95% CI] 11.29 [8.63–14.75] for < 50 years; 6.16 [5.21–7.29] for 50–65 years), male (aHR 1.67 [1.52–1.87]), current smoker (aHR 1.31 [1.00–1.72], lower-income status (aHR 1.46 [1.17, 1.84]), and high education level (aHR 1.30 [1.01–1.67]) were associated with being unvaccinated. Also, a poorer glycemic control with HbA1c ≥ 9% was found to be correlated with unvaccinated status (aHR 1.48 [1.15–1.90]).ConclusionThe influenza vaccination rate is still unsatisfactory in subjects with diabetes. Young age, males, low-income level, high education level, and poor glycemic control were associated with unvaccinated status. Considering the risk-benefits of influenza vaccination in patients with diabetes, physicians should make an effort to increase vaccination rates, especially in low vaccination rate groups.

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“…Regarding education level, findings from previous studies have been conflicting, particularly in relation to the association between education level and vaccination status. A study conducted in South Korea reported that individuals with higher education levels had lower vaccination rates[ 23 ]. In our study, we observed a non-statistically significant difference in vaccination status among individuals with varying educational levels, ranging from those below primary school to postgraduates.…”

“…Conversely, another study conducted in South Korea revealed that better glycemic control, evidenced by lower HbA1c levels, was associated with higher vaccine coverage. This was rationalized as poor glycemic control correlating with less adherence to medical advice and, therefore, lower vaccine coverage[ 23 ].…”