The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study
Objective To investigate the impact on mortality due to pneumonia or influenza of the change from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales.Design Excess mortality estimated using time series of deaths registered to pneumonia or infl...
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BMJ Publishing Group
2013-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/3/8/e002743.full |
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| author | Andrea G Mann Punam Mangtani Colin A Russell John C Whittaker |
| author_facet | Andrea G Mann Punam Mangtani Colin A Russell John C Whittaker |
| author_sort | Andrea G Mann |
| collection | DOAJ |
| description | Objective To investigate the impact on mortality due to pneumonia or influenza of the change from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales.Design Excess mortality estimated using time series of deaths registered to pneumonia or influenza, accounting for seasonality, trend and artefacts. Non-excess mortality plotted as proxy for long-term trend in mortality.Setting England and Wales.Participants Persons aged 65–74 and 75+ years whose deaths were registered to underlying pneumonia or influenza between 1975/1976 and 2004/2005.Outcome measures Multiplicative effect on average excess pneumonia and influenza deaths each winter in the 4–6 winters since age group-based targeting of vaccination was introduced (in persons aged 75+ years from 1998/1999; in persons aged 65+ years from 2000/2001), estimated using multivariable regression adjusted for temperature, antigenic drift and vaccine mismatch, and stratified by dominant circulating influenza subtype. Trend in baseline weekly pneumonia and influenza death rates.Results There is a suggestion of lower average excess mortality in the six winters after age group-based targeting began compared to before, but the CI for the 65–74 years age group includes no difference. Trend in baseline pneumonia and influenza mortality shows an apparent downward turning point around 2000 for the 65–74 years age group and from the mid-1990s in the 75+ years age group.Conclusions There is weakly supportive evidence that the marked increases in vaccine coverage accompanying the switch from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales were associated with lower levels of pneumonia and influenza mortality in older people in the first 6 years after age group-based targeting began. The possible impact of these policy changes is observed as weak evidence for lower average excess mortality as well as a turning point in baseline mortality coincident with the changes. |
| format | Article |
| id | doaj-art-dbc6bc667a894bb1bf4816a2963da973 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2013-08-01 |
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| series | BMJ Open |
| spelling | doaj-art-dbc6bc667a894bb1bf4816a2963da9732025-08-20T02:13:48ZengBMJ Publishing GroupBMJ Open2044-60552013-08-013810.1136/bmjopen-2013-002743The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend studyAndrea G Mann0Punam Mangtani1Colin A Russell2John C Whittaker3Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UKDepartment of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, UKDepartment of Medical Microbiology, Amsterdam University Medical Center, Amsterdam, The NetherlandsDepartment of Non-Communicable Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UKObjective To investigate the impact on mortality due to pneumonia or influenza of the change from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales.Design Excess mortality estimated using time series of deaths registered to pneumonia or influenza, accounting for seasonality, trend and artefacts. Non-excess mortality plotted as proxy for long-term trend in mortality.Setting England and Wales.Participants Persons aged 65–74 and 75+ years whose deaths were registered to underlying pneumonia or influenza between 1975/1976 and 2004/2005.Outcome measures Multiplicative effect on average excess pneumonia and influenza deaths each winter in the 4–6 winters since age group-based targeting of vaccination was introduced (in persons aged 75+ years from 1998/1999; in persons aged 65+ years from 2000/2001), estimated using multivariable regression adjusted for temperature, antigenic drift and vaccine mismatch, and stratified by dominant circulating influenza subtype. Trend in baseline weekly pneumonia and influenza death rates.Results There is a suggestion of lower average excess mortality in the six winters after age group-based targeting began compared to before, but the CI for the 65–74 years age group includes no difference. Trend in baseline pneumonia and influenza mortality shows an apparent downward turning point around 2000 for the 65–74 years age group and from the mid-1990s in the 75+ years age group.Conclusions There is weakly supportive evidence that the marked increases in vaccine coverage accompanying the switch from risk-based to age group-based targeting of the elderly for yearly influenza vaccination in England and Wales were associated with lower levels of pneumonia and influenza mortality in older people in the first 6 years after age group-based targeting began. The possible impact of these policy changes is observed as weak evidence for lower average excess mortality as well as a turning point in baseline mortality coincident with the changes.https://bmjopen.bmj.com/content/3/8/e002743.full |
| spellingShingle | Andrea G Mann Punam Mangtani Colin A Russell John C Whittaker The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study BMJ Open |
| title | The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study |
| title_full | The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study |
| title_fullStr | The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study |
| title_full_unstemmed | The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study |
| title_short | The impact of targeting all elderly persons in England and Wales for yearly influenza vaccination: excess mortality due to pneumonia or influenza and time trend study |
| title_sort | impact of targeting all elderly persons in england and wales for yearly influenza vaccination excess mortality due to pneumonia or influenza and time trend study |
| url | https://bmjopen.bmj.com/content/3/8/e002743.full |
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