The association between influenza vaccination and socioeconomic status in high income countries varies by the measure used: a systematic review

Abstract

Background The purpose of this paper is to systematically review the literature on the relationship between socioeconomic status (SES) and influenza immunization and to examine how certain measures of SES may influence interpretations of this relationship. Methods We conducted a systematic review of existing peer-reviewed literature to evaluate the above relationship in the general population. Electronic databases (MEDLINE and EMBASE) were searched from January 2012 to May 2017 to identify English-language studies relevant to this review. Studies were included where influenza vaccination was explicitly reported as the dependent variable and SES as the independent variable. We limited our review to measures of SES that focus on education, income, social class, occupation, and deprivation. Studies that measured SES using other variables (e.g., race, ethnicity, geographic location, rural or urban status, or insurance status) were excluded. Studies were also excluded if they did not report on the human population or did not analyze original data. The population of interest included all age groups, levels of health status, and sociodemographic backgrounds. The review was also limited to World Bank high-income countries. Two authors independently screened full-text articles after obtaining a Kappa score of K = 0.867. The methodological quality of manuscripts was assessed using the appraisal tools developed by the Joanna Briggs Institute. Results were qualitatively reported and synthesized. Results Of the 42 articles included in this review, 52.4% ( n = 22) found that higher levels of SES resulted in higher levels of influenza vaccination; 4.5% ( n = 2) reported a negative association; and 14.3% ( n = 6) found no association. Just over a quarter (26.2%, n = 12) of articles reported mixed results. Conclusions There was consistently a relationship between SES and influenza immunization, which varied according to how SES was measured. It is recommended that authors be explicit in defining the SES concept they are trying to capture and that they utilize multiple measures of SES (e.g., education, income, class). Electronic supplementary material The online version of this article (10.1186/s12874-019-0801-1) contains supplementary material, which is available to authorized users.

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“…with education, socioeconomic status and employments as the main associated factors. A systematic review written by Kelsey reported that higher levels of socio economic status resulted in higher levels of influenza vaccination; 4.5% reported a negative association; and 14.3% found no association (Lucyk et al 2019).…”

Health inequities in influenza transmission and surveillance

“…This result could reflect vaccination-seeking behavior being higher in areas where influenza rates are typically high thus increasing disease risk perception [40]. Additionally, some prior studies have shown mixed results regarding the relationship between socioeconomic status and influenza vaccination, and that these differing results may relate to the way that socioeconomic status is defined, or what location the study takes place in [41, 42]. Lastly, this may be a result of the source of our vaccination data, which has low coverage in some areas and may suffer from its own measurement biases, which highlights the need for more data on influenza vaccine uptake and the characteristics of those who vaccinate.…”