Amicizia, D.

Gasparini, R.

Panatto, D.

English

Panatto D.

Gasparini R.

Amicizia D.

Archivio istituzionale della ricerca - Università di Genova

J PREV MED HYG 2018; 59: (SUPPL. 2): E1-E2E1PrefaceInfluenza vaccination coverage in the elderly  and socio-economic inequalities in ItalyD. PANATTO, R. GASPARINI, D. AMICIZIADepartment of Health Sciences (DISSAL), University of Genoa, Italyhttp://dx.doi.org/10.15167/2421-4248/jpmh2018.59.4s2.1198Every year, seasonal  influenza  epidemics affect about 5-15% of the world’s population, resulting in 3-5 mil-lion serious cases and 290,000-650,000 deaths [1]. The WHO defines seasonal influenza as a year-round dis-ease burden, causing illnesses that ranges in severity and sometimes leads to hospitalization and death [1]. Some frail subjects, such as the elderly, are considered at high risk of complications, hospitalization and death [2-4]. Routine annual vaccination is the most effective means of avoiding influenza illness, reducing the associated complications and, consequently, reducing the impact of epidemics, and is strongly recommended by many health authorities worldwide [1, 5, 6]. Italy has a national influ-enza  vaccination programme which identifies specific categories, such as subjects with chronic conditions, pregnant women, healthcare workers and those over 65 years old, which can benefit from free vaccination [7]. Despite this health opportunity, the influenza coverage rate in Italy does not reach the minimum recommended threshold of 75% and is far from the optimum target of 95% [8]. Indeed, a downward trend in coverage in the elderly has been observed since the 2009-2010 season; the average national coverage rate fell from 65.6% in 2009-2010 to 49% in 2014-2015 (its lowest value); a slight upward trend was recorded in the 2016-2017 and 2017-2018 seasons, when coverage reached 52.6% and 52.7%, respectively [4, 8].This unsatisfactory level of coverage results in excessive recourse to Emergency Departments and in an increase in hospital accesses and hospitalization for complica-tions in the elderly during epidemic peaks, causing or-ganizational strain and increasing healthcare costs [5, 6].Some interventions could improve coverage rates among the elderly, such as “tailor-made” information campaigns using innovative communication strategies and health-care worker training. It is crucial to implement commu-nication strategies that take into account the needs of the elderly population, while also involving elderly people’s associations in awareness-raising activities. Moreover, strengthening the role of general practitioners in promot-ing influenza vaccination is fundamental.Several international studies have shown that socio-eco-nomic conditions and deprivation play an important role in the lack of adherence to vaccination [9-12]. Specifi-cally, studies investigating the role of socio-economic status (SES) have highlighted the correlation between deprivation and low vaccination coverage among groups at risk, such as the elderly. Indeed, SES is one of the main determinants of health, and affects the subject’s ability to fully comply with preventive measures and healthcare prescriptions. Moreover, it assumes great rel-evance with regard to age and non-compliance with in-fluenza vaccination [10].In order to implement efficacious interventions to pro-mote vaccination, it is important to understand the rea-sons behind non-compliance. This aspect could be inves-tigated by implementing a model based on the intention to vaccinate, and adapting this to older people [13-15].In this context, we designed and developed a project aimed at evaluating the association between vaccination coverage and socio-economic health inequalities in the elderly. The study was carried out in 10 Italian areas: Genoa, Ferrara, some cities in Veneto, Sassari, Cagliari, Rome, Florence, Siena, Foggia and Palermo. In order to better identify sub-groups of the population who do not comply with vaccination, we used socio-economic indicators that are able to detect the multidimensional aspects of social stratification. Indeed, indices of SES enable us to identify and evaluate the relationship be-tween socio-economic inequalities and health outcomes. As these indices yield a geographical description of the population’s health conditions and approximate the in-dividual SES to that of the area of  residence, they have already proved able to identify populations at risk of late diagnosis and/or under-treatment for chronic/degen-erative diseases [16-19]. This information could be used to guide “tailor-made” interventions to promote health and vaccination in Italy. Furthermore, in support of this methodology, a specific WHO programme [20] encour-ages precisely this type of action, which must be adapted to the peculiarities of the specific areas. Finally, the need to improve vaccination coverage in the elderly should be considered in the current and future demographic context. Given the ageing of the popu-lation, the demand for health care will increase in the coming years and, consequently, a greater burden will be placed on economic resources. Preventive action to promote “healthy ageing” is therefore fundamental, and vaccinations fall within this perspective.References[1] World Health Organization (WHO). Available at: www.who.int/influenza/surveillance_monitoring/bod/en. [Accessed on 2018, November].[2] Torner N, Navas E, Soldevila N, Toledo D, Navarro G, Moril-lo A, Pérez MJ, Domínguez A; Working Group of the Project PI12/02079. Costs associated with influenza-related hospitali-zation in the elderly. Hum Vaccin Immunother 2017;13:412-6. doi: 10.1080/21645515.2017.1264829. [3] Rodrigues E, Machado A, Silva S, Nunes B. Excess pneumonia D. PANATTO ET AL.E2and influenza hospitalizations associated with influenza epi-demics in Portugal from season 1998/1999 to 2014/2015. Influ-enza Other Respir Viruses 2018;12:153-60. [4] Amicizia D, Lai PL, Gasparini R, Panatto D. Influenza vaccina-tion of elderly: relaunch time. Ann Ig 2018;30(Suppl 1):16-22. doi: 10.7416/ai.2018.2229.[5] Barbieri M, Capri S, Waure C, Boccalini S, Panatto D. Age- and risk-related appropriateness of the use of available influenza vaccines in the Italian elderly population is advantageous: results from a budget impact analysis. J Prev Med Hyg 2017;58:E279-87. doi: 10.15167/2421-4248/jpmh2017.58.4.867.[6] Capri S, Barbieri M, de Waure C, Boccalini S, Panatto D. Cost-effectiveness analysis of different seasonal influenza vaccines in the elderly Italian population. Hum Vaccin Immunother 2018;14:1331-41. doi:10.1080/21645515.2018.1438792.[7] Circolare ministeriale. Prevenzione e controllo dell’influenza: raccomandazioni per la stagione 2018-2019. Available at: www.http://www.trovanorme.salute.gov.it/norme/renderNormsanPdf?anno=2018&codLeg=64381&parte=1%20&serie=null. [Ac-cessed on 2018, November].[8] Influenza. Coperture della vaccinazione antinfluenzale in Italia. Available at: www.epicentro.iss.it/influenza/coperture-vacci-nali. [Accessed on 2018, November].[9] Peretti-Watel P, Raude J, Sagaon-Teyssier L, Constant A, Verger P, Beck F. Attitudes toward vaccination and the H1N1 vaccine: poor people’s unfounded fears or legitimate concerns of the elite? Soc Sci Med 2014;109:10-8.[10] Nagata JM, Hernández-Ramos I, Kurup AS, Albrecht D, Vivas-Torrealba C, Franco-Paredes C. Social determinants of health and seasonal influenza vaccination in adults ≥ 65 years: a sys-tematic review of qualitative and quantitative data. BMC Public Health 2013;25;13:388.[11] Damiani G, Federico B, Visca M, Agostini F, Ricciardi W. The impact of socioeconomic level on influenza vaccination among Italian adults and elderly: a cross-sectional study. Preventive Medicine 2007;45:373-9.[12] Vukovic V, Lillini R, Lupi S, Fortunato F, Cicconi M, Matteo G, Arata L, Amicizia D, Boccalini S, Bechini A, Prato R, Stefanati A, Panatto D, de Waure C. Identifying people at risk for influ-enza with low vaccine uptake based on deprivation status: a sys-tematic review. Eur J Public Health 2018. doi:0.1093/eurpub/cky264.[13] Ajzen I. The theory of planned behavior. Organizational Behav-ior and Human Decision Processes 1991;50.[14] Bonetti L, Bagnasco A, Aleo G, Sasso L. Validation of the staff attitudes to nutritional nursing care geriatric scale. Int Nurs Rev 2013;60:389-96.[15] Bagnasco A, Rosa F, Aleo G, Sasso L. Care competence in nurs-ing education. Journal of European CME 2012;1:18-9.[16] Caranci N, Costa G. Un indice di deprivazione a livello aggre-gato da utilizzare su scala nazionale: giustificazioni e compo-sizione dell’indice. In: Costa G, Cislaghi C, Caranci N (eds.). Disuguaglianze sociali di salute. Problemi di definizione e di misura. Salute e Società 2009;7:1.[17] Lillini R, Quaglia A, Vercelli M; Registro mortalità Regione Liguria. Building of a local deprivation index to measure the health status in the Liguria Region. Epidemiologia e Prevenzione 2012;36:180-7.[18] Woods LM, Rachet B, Coleman MP. Choice of geographic unit influences socioeconomic inequalities in breast cancer survival. Br J Cancer 2005;92:1279-82.[19] Quaglia A, Lillini R, Casella C, Giachero G, Izzotti A, Vercelli M, Liguria Region Tumour Registry. The combined effect of age and socio-economic status on breast cancer survival. Crit Rev Oncol Hematol 2011;77:210-20.[20] AA.VV. The Guide to Tailoring Immunization Programmes (TIP). Geneve: WHO 2013.

Influenza vaccination coverage in the elderly and socio-economic inequalities in Italy

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Journal of Preventive Medicine and Hygiene (JPMH)