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Factors influencing influenza, pneumococcal and shingles vaccine uptake and refusal in older adults: a population-based cross-sectional study in England.

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Clift, Ashley Kieran  ORCID logo
Dambha-Miller, Hajira 
Saatci, Defne 


OBJECTIVES: Uptake of influenza, pneumococcal and shingles vaccines in older adults vary across regions and socioeconomic backgrounds. In this study, we study the coverage and factors associated with vaccination uptake, as well as refusal in the unvaccinated population and their associations with ethnicity, deprivation, household size and health conditions. DESIGN, SETTING AND PARTICIPANTS: This is a cross-sectional study of adults aged 65 years or older in England, using a large primary care database. Associations of vaccine uptake and refusal in the unvaccinated with ethnicity, deprivation, household size and health conditions were modelled using multivariable logistic regression. OUTCOME MEASURE: Influenza, pneumococcal and shingles vaccine uptake and refusal (in the unvaccinated). RESULTS: This study included 2 054 463 patients from 1318 general practices. 1 711 465 (83.3%) received at least one influenza vaccine, 1 391 228 (67.7%) pneumococcal vaccine and 690 783 (53.4%) shingles vaccine. Compared with White ethnicity, influenza vaccine uptake was lower in Chinese (OR 0.49; 95% CI 0.45 to 0.53), 'Other ethnic' groups (0.63; 95% CI 0.60 to 0.65), black Caribbean (0.68; 95% CI 0.64 to 0.71) and black African (0.72; 95% CI 0.68 to 0.77). There was generally lower vaccination uptake among more deprived individuals, people living in larger household sizes (three or more persons) and those with fewer health conditions. Among those who were unvaccinated, higher odds of refusal were associated with the black Caribbean ethnic group and marginally with increased deprivation, but not associated with higher refusal in those living in large households or those with lesser health conditions. CONCLUSION: Certain ethnic minority groups, deprived populations, large households and 'healthier' individuals were less likely to receive a vaccine, although higher refusal was only associated with ethnicity and deprivation but not larger households nor healthier individuals. Understanding these may inform tailored public health messaging to different communities for equitable implementation of vaccination programmes.


Peer reviewed: True


EPIDEMIOLOGY, Epidemiology, PRIMARY CARE, Public health, Humans, Aged, Influenza Vaccines, Influenza, Human, Herpes Zoster Vaccine, Cross-Sectional Studies, Ethnicity, Minority Groups, Herpes Zoster, Pneumococcal Vaccines, Streptococcus pneumoniae

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BMJ Open

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Cancer Research UK (C2195/A31310, C5255/A18085)
NIHR Leicester Biomedical Research Centre (NIHR200171)
UK Research and Innovation (COV0130 /MR/V027778/1)
Oxford Wellcome Institutional Strategic Support Fund (204826/Z/16/Z)
MRC Epidemiology Unit (MC_UU_12015/4)
NIHR (COV0130 /MR/V027778/1, NA)
John Fell Oxford University Press Research Fund (NA)
NIHR Applied Research Collaboration East Midlands (NIHR200171)
NHS East of England (NA)