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Med Care. 2013 Dec;51(12):1106-13. doi: 10.1097/MLR.0b013e3182a50297.

Hospitalization and skilled nursing care are predictors of influenza vaccination among patients on hemodialysis: evidence of confounding by frailty.

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1
Departments of *Epidemiology, Gillings School of Global Public Health †Medicine, Division of Nephrology and Hypertension ‡Medicine, Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC.

Abstract

BACKGROUND:

Observational studies of preventive medications, such as vaccinations, can suffer from the healthy-user bias because vaccinated patients may be healthier than unvaccinated patients. Indicators of health status and frailty suitable for attenuating this bias could be identified in administrative data.

OBJECTIVE:

To examine the association of baseline variables and time-dependent hospitalization and skilled nursing care with the receipt of influenza vaccination in patients with end-stage renal disease.

RESEARCH DESIGN:

Observational cohort study using United States Renal Data System files each year from 1999 to 2005.

SUBJECTS:

Population-based cohorts that included >115,000 adult, hemodialysis patients each year.

MEASURES:

We estimated hazard ratios for the association of baseline variables and time-dependent hospitalization days and skilled nursing days with influenza vaccination, controlling for demographic and baseline health status variables.

RESULTS:

Vaccination coverage increased from 47% in 1999 to 60% in 2005. Patients with any length of hospitalization were less likely to be vaccinated, however, the association was stronger in patients with longer stays [15-25 d: hazard ratio=0.64 (95% confidence interval, 0.62-0.65); 26-30 d: 0.40 (0.38-0.42)]. Patients with any length of skilled nursing care of >1 day had similar estimates; these patients were also less likely to be vaccinated [26-30 d: 0.66 (0.64-0.69)].

CONCLUSIONS:

Patients with long hospitalizations or skilled nursing stays were less likely to be vaccinated suggesting evidence of the healthy-user effect. These variables could be used to account for bias in studies of preventive services in patients on dialysis.

PMID:
23969584
PMCID:
PMC5495477
DOI:
10.1097/MLR.0b013e3182a50297
[Indexed for MEDLINE]
Free PMC Article
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