Mortality attributable to smoking in Vietnamese men in 2008

Objective

Smoking prevalence among Vietnamese men is among the highest in the world. Our aim was to provide estimates of tobacco attributable mortality to support tobacco control policies.

Method

We used the Peto–Lopez method using lung cancer mortality to derive a Smoking Impact Ratio (SIR) as a marker of cumulative exposure to smoking. SIRs were applied to relative risks from the Cancer Prevention Study, Phase II. Prevalence-based and hybrid methods, using the SIR for cancers and chronic obstructive pulmonary disease and smoking prevalence for all other outcomes, were used in sensitivity analyses.

Results

When lung cancer was used to measure cumulative smoking exposure, 28% (95% uncertainty interval 24–31%) of all adult male deaths (> 35 years) in Vietnam in 2008 were attributable to smoking. Lower estimates resulted from prevalence-based methods [24% (95% uncertainty interval 21–26%)] with the hybrid method yielding intermediate estimates [26% (95% uncertainty interval 23–28%)].

Conclusion

Despite uncertainty in these estimates of attributable mortality, tobacco smoking is already a major risk factor for death in Vietnamese men. Given the high current prevalence of smoking, this has important implications not only for preventing the uptake of tobacco but also for immediate action to adopt and enforce stronger tobacco control measures.     

Insufficient and excessive amounts of sleep increase the risk of premature death from cardiovascular and other diseases: The Multiethnic Cohort Study

Objective

To explore an independent association between self-reported sleep duration and cause-specific mortality.

Methods

Data were obtained from the Multiethnic Cohort Study conducted in Los Angeles and Hawaii.

Results

Among 61,936 men and 73,749 women with no history of cancer, heart attack or stroke, 19,335 deaths occurred during an average 12.9 year follow-up. Shorter (≤ 5 h/day) and longer (≥ 9 h/day) sleepers of both sexes (vs. 7 h/day) had an increased risk of all-cause and cardiovascular disease (CVD) mortality, but not of cancer mortality. Multivariable hazard ratios for CVD mortality were 1.13 (95% CI 1.00–1.28) for ≤ 5 h/day and 1.22 (95% CI 1.09–1.35) for ≥ 9 h/day among men; and 1.20 (95% CI 1.05–1.36) for ≤ 5 h/day and 1.29 (95% CI 1.13–1.47) for ≥ 9 h/day among women. This risk pattern was not heterogeneous across specific causes of CVD death among men (P_hetero 0.53) or among women (P_hetero 0.72). The U-shape association for all-cause and CVD mortality was observed in all five ethnic groups included in the study and by subgroups of age, smoking status, and body mass index.

Conclusion

Insufficient or excessive amounts of sleep were associated with increased risk of mortality from CVD and other diseases in a multiethnic population.     

How many deaths are attributable to smoking in the United States? Comparison of methods for estimating smoking-attributable mortality when smoking prevalence changes

Background

The number of smoking-attributable deaths is commonly estimated using current and former smoking prevalences or lung cancer mortality as an indirect metric of cumulative population smoking. Neither method accounts for differences in the timing with which relative risks (RRs) for different diseases change following smoking initiation and cessation. We aimed to develop a method to account for time-dependent RRs.

Methods

We used birth cohort lung cancer mortality and its change over time to characterize time-varying cumulative smoking exposure. We analyzed data from the American Cancer Society Cancer Prevention Study II to estimate RRs for disease-specific mortality associated with current and former smoking, and change in RRs over time after cessation.

Results

When lung cancer was used to measure cumulative smoking exposure, 254,700 male and 227,000 female deaths were attributed to smoking in the US in 2005. A modified method in which RRs for different diseases decreased at different rates after cessation yielded similar but slightly lower estimates [251,900 (male) and 221,100 (female)]. The lowest estimates resulted from the method based on smoking prevalence [225,800 (male) and 163,700 (female)].

Conclusions

Although all methods estimated a large number of smoking attributable deaths, future efforts should account for temporal changes in smoking prevalence and in accumulation/reversibility of disease-specific risks.     

Circulating 25-hydroxyvitamin D serum concentration and total cancer incidence and mortality: A systematic review and meta-analysis

Objective

To conduct a systematic review and meta-analysis of longitudinal studies on the association of 25(OH)D with total cancer incidence and mortality.

Method

Relevant longitudinal observational studies were identified by systematically searching Ovid Medline, EMBASE, and ISI Web of Knowledge databases. Due to the heterogeneity across studies in categorizing 25(OH)D concentration, all results were recalculated for an increase of 25(OH)D by 50 nmol/L.

Results

In meta-analyses with random effects models, the summary risk ratios and confidence intervals (RRs (95% CI)) for the association of an increase of 25(OH)D by 50 nmol/L with total cancer incidence (5 studies) and mortality (13 studies) were 0.89 (0.81, 0.97) and 0.83 (0.71, 0.96), respectively. In sex-specific analyses no significant association with total cancer incidence was observed among men or women. A clear inverse association with total cancer mortality was observed among women (0.76 (0.60, 0.98)) but not among men (0.92 (0.65, 1.32)). Large heterogeneity was observed for studies on total cancer mortality (P < 0.01) but not for studies on cancer incidence (P = 0.41). No publication bias was found.

Conclusion

The meta-analysis suggests a moderate inverse association of 25(OH)D concentration with total cancer incidence and mortality.     

Influence of gender role attitudes on smoking and drinking among girls from Jujuy,Argentina

Objective

Evaluate effect of gender role attitudes on tobacco and alcohol use among Argentinean girls.

Method

Cross-sectional survey of 10th grade students attending 27 randomly selected schools in Jujuy, Argentina. Questions about tobacco and alcohol use were adapted from global youth surveys. Five items with 5-point response options of agreement–disagreement assessed attitude towards egalitarian (higher score) gender roles.

Results

2133 girls, aged 13–18 years, 71% Indigenous, 22% mixed Indigenous/European, and 7% European responded. Of these, 60% had ever smoked, 32% were current smokers, 58% ever drinkers, 27% drank in previous month, and 13% had ≥ 5 drinks on one occasion. Mean response to the gender role scale was 3.49 (95% Confidence Intervals = 3.41–3.57) out of 5 tending toward egalitarian attitudes. Logistic regression models using the gender role scale score as the main predictor and adjusting for demographic and social confounders showed that egalitarian gender role was associated with ever smoking (Odds Ratio = 1.25; 95% Confidence Intervals 1.09–1.44), ever drinking (Odds Ratio = 1.24; 95% Confidence Intervals 1.10–1.40), drinking in prior month (Odds Ratio = 1.21; 95% Confidence Intervals 1.07–1.37) and ≥ 5 drinks on one occasion (Odds Ratio = 1.15; 95% Confidence Intervals 1.00–1.33), but was not significant for current smoking.

Conclusion

Girls in Jujuy who reported more egalitarian gender role attitudes had higher odds of smoking or drinking.     

Smoking prevalence and its impacts on lung cancer mortality in Sub-Saharan Africa: An epidemiological study

Background

Reliable mortality data are sparse for developing countries. Furthermore, risk factor prevalence information is hardly available and thus not taken into consideration when estimating mortality.

Methods

The authors used a validated, statistical model combined with representative smoking prevalence from WHO STEPS surveys to estimate lung cancer mortality for six Sub-Saharan African countries (Benin, Malawi, Mozambique, Niger, Sierra Leone, Swaziland). Results were compared to a reference database (GLOBOCAN). Using different smoking prevalence scenarios, future lung cancer deaths were estimated.

Results

The prevalence of current moderate smoking among males ranged from 8.7% to 34.6%. Prevalence was much lower among females. For all countries considered, our mortality estimates were higher than GLOBOCAN estimates that do not consider prevalence: Overall, we estimated 2405 lung cancer deaths for 2008 compared to 531 deaths estimated by GLOBOCAN. Up to 2030, lung cancer deaths are expected to increase in general and by over 100% in Benin and Niger. Even under the assumption of decrease in smoking prevalence, lung cancer mortality will rise.

Conclusion

On the bases of detailed smoking prevalence information, our findings implicate a higher lung cancer burden in low income countries. The epidemiologic transition in African low-income countries alludes to the need for targeted health prevention efforts.     

Patient knowledge and beliefs as barriers to extending cervical cancer screening intervals in Federally Qualified Health Centers

Objective

Despite guidelines recommending cervical cancer screening intervals be extended beyond one year, clinical practice has been slow to change. Patient preferences are a potential barrier. In the Centers for Disease Control's Cervical Cancer (Cx3) Study at Federally Qualified Health Centers (FQHCs) across Illinois, we surveyed patients about screening practices, and assessed beliefs regarding lengthening screening intervals.

Method

We analyzed data from 984 low income women in the Cx3 Study (2009–2011). Participants completed a survey assessing health history, knowledge about Pap testing, beliefs and intentions about extending screening intervals, and demographics.

Results

The majority reported annual Pap testing (61%), while only 24% reported a 2–3 year screening interval (recommendation at time of survey). Misunderstandings about the Pap test were prevalent, with over half believing it screened for vaginal, yeast, and sexually transmitted infections (58%–72%). Unfavorable beliefs about extending screening intervals were common. The majority (57%) indicated that they would not wait 3 years to be screened if their physician recommended it, and intentions were associated with knowledge about Pap testing.

Conclusion

Most women reported annual cervical cancer screening, and intended to resist longer screening intervals. Patients' lack of knowledge and unfavorable beliefs may serve as barriers to extending screening intervals.     

Sustained high influenza vaccination rates and decreased safety concerns among pregnant women during the 2010–2011 influenza season

Objective

Intense efforts to vaccinate pregnant women against 2009 H1N1 influenza resulted in much higher vaccine uptake than previously reported. We surveyed postpartum women to determine whether high vaccination rates were sustained during the 2010–11 influenza season.

Methods

We performed cross-sectional surveys of postpartum women delivering at our institution during February–April 2010 and February–March 2011. The surveys ascertained maternal characteristics, history of influenza vaccination, and reasons for lack of vaccination.

Results

During the 2010–11 season, 165 (55%) of 300 women surveyed reported receiving influenza vaccination, compared to 191 of 307 (62%) during 2009–10 (p = 0.08). Vaccination by an obstetrical provider was common, but decreased compared to 2009–10 (60% vs. 71%, p = 0.04). While most women (76%) in 2010–11 reported that their provider recommended influenza vaccination, significantly more reported lack of discussion about vaccination (24% vs. 11%, p < 0.01) compared to 2009–10. Vaccine safety concerns were cited by most (66%) women declining vaccination during 2009–10 but only 27% of women who declined in 2010–11.

Conclusion

The vaccination rate among pregnant women at our institution was relatively sustained, although fewer providers appear to be discussing influenza vaccination in pregnancy. Concern about vaccine safety, the primary barrier during 2009–10, was much less prominent.     

J-shaped association between plasma glucose concentration and cardiovascular disease mortality over a follow-up of 32 years

Objective

We aimed at examining the association between plasma glucose (PG) concentration and cardiovascular mortality in a population sample from Switzerland over a follow-up time of 32 years.

Methods

We analyzed 7984 men and women enrolled in the first National Research Program (NRP1A, 1977–1979) and followed up for survival until 2008. Mortality hazard ratios (HR) were calculated using adjusted Cox regression models. PG was measured in fasting state or randomly with known fasting time. Models were adjusted for age, sex, socio-demographic, lifestyle and cardiovascular risk factors.

Results

PG concentrations ≥ 6.1 mmol/L were associated with increased risk of cardiovascular disease (CVD) and all-cause mortality. Compared to normal PG (3.8–4.9 mmol/L) the adjusted HR (95% CI) for CVD mortality was 1.26 (1.01–1.58) for PG ≥ 6.1–6.9 mmol/L, 1.56 (1.18–2.06) for PG ≥ 7 mmol/L, 1.67 (1.22–2.30) for known diabetes. All-cause mortality essentially showed the same patterns. All-cause mortality was increased [1.35 (1.01–1.80)] also for PG < 3.8 mmol/L.

Conclusion

Plasma glucose remained significantly and independently associated with CVD mortality even after full follow-up. The relationship was J-shaped. In order to prevent premature death, persons with abnormal PG concentrations on both extremes should be screened and counseled for other CVD risk factors.     

Patient-reported recall of smoking cessation interventions from a health professional

Objective

To determine the prevalence and characteristics of current cigarette smokers who report receiving health care provider interventions (‘5A's’: ask, advise, assess, assist, arrange) for smoking cessation.

Methods

Data came from the 2009–2010 National Adult Tobacco Survey, a telephone survey of United States adults aged ≥ 18 years. Among current cigarette smokers who reported visiting a health professional in the past year (n = 16,542), estimates were calculated overall and by sex, age, race/ethnicity, education, income, health insurance coverage, and sexual orientation.

Results

Among smokers who visited a health professional (75.2%), 87.9% were asked if they used tobacco, 65.8% were advised to quit, and 42.6% were asked if they wanted to quit. Among those wanting to quit, 78.2% were offered assistance and 17.5% had follow-up arranged. Receipt of the ‘ask’ component was lower among males and uninsured individuals. Receipt of the ‘advise’ and ‘assess’ components was lower among those aged 18–24 and uninsured individuals. Receipt of the ‘assist’ component was lower among non-Hispanic blacks. No differences were observed for the ‘arrange’ component.

Conclusions

Many current smokers report receiving health care provider interventions for smoking cessation. Continued efforts to educate, encourage, and support all health professionals to provide effective, comprehensive tobacco cessation interventions to their patients may be beneficial.     

Cumulative exposure to particulate matter air pollution and long-term post-myocardial infarction outcomes

Introduction

Chronic environmental exposure to particulate matter < 2.5 μm in diameter (PM_2.5) has been associated with cardiovascular disease; however, the effect of air pollution on myocardial infarction (MI) survivors is not clear. We studied the association of chronic exposure to PM_2.5 with death and recurrent cardiovascular events in MI survivors.

Methods

Consecutive patients aged ≤ 65 years admitted to all medical centers in central Israel after first-MI in 1992–1993 were followed through 2005 for cardiovascular events and 2011 for survival. Data on sociodemographic and prognostic factors were collected at baseline and during follow-up. Residential exposure to PM_2.5 was estimated for each patient based on data recorded at air quality monitoring stations. Cox and Andersen–Gill proportional hazards models were used to study the pollution-outcome association.

Results

Among the 1120 patients, 469 (41.9%) died and 541 (48.3%) experienced one or more recurrent cardiovascular event. The adjusted hazard ratios associated with a 10 μg/m³ increase in PM_2.5 exposure were 1.3 (95% CI 0.8–2.1) for death and 1.5 (95% CI 1.1–1.9) for multiple recurrences of cardiovascular events (MI, heart failure and stroke).

Conclusion

When adjustment for socio-demographic factors is performed, cumulative chronic exposure to PM_2.5 is positively associated with recurrence of cardiovascular events in patients after a first MI.     

Patient–provider communication and timely receipt of preventive services

Objective

To estimate the association between how patients rate their health care provider's communication and the receipt of six clinical preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) and the Advisory Committee on Immunization Practices (ACIP).

Methods

This study used national data from the 2009 Medical Expenditure Panel Survey (MEPS). The samples (sizes vary by service) included individuals aged 18 years and older who have a usual source of care (USC). The outcomes indicated whether or not individuals received screening for breast cancer, cervical cancer, colon cancer, high cholesterol, hypertension, or were vaccinated against influenza per clinical guidelines. Multivariate logistic regression models were created for each dependent variable. The main independent variables consisted of ratings of four patient–provider communication behaviors.

Results

In unadjusted analyses, respondents who rated their providers' communication higher reported greater utilization of preventive services. After controlling for confounding variables, only receipt of mammograms remained significantly associated with better communication (p < 0.05). Screening for cervical cancer, colon cancer, high cholesterol, and influenza vaccination approached significance with better communication (p < 0.10).

Conclusions

Patient–provider communication is associated with receipt of regular mammograms. Clinicians should consider their medical dialogue with patients as a stimulus for appropriate screenings and vaccinations.     

Life-style and self-rated global health in Sweden: A prospective analysis spanning three decades

Objective

To study the relations between lifestyle factors (smoking, drinking, exercise, vegetable consumption, social relations) and global self-rated health in the adult Swedish population.

Method

The data come from the Swedish Level of Living Survey, a face-to-face panel study. The analysis follows the respondents with good health in 1991 (N = 4035) and uses multivariate logistic regression to assess the relations between lifestyle factors in 1991 and health in 2000 and 2010.

Results

Baseline (1991) exercise, social support, smoking and vegetable consumption are associated with health in 2000 and/or 2010. 2000: Weekly exercise in 1991 increases the probability of good health by 6 percentage points [95% CI: 1–10] compared to no exercise, and smoking 10 or more cigarettes a day decreases the probability of good health by 5 percentage points [95% CI 1–8]. Lacking social support decreases the probability of good health by 17 percentage points (95% CI: 9–25). 2010: Smoking 10 or more cigarettes a day decreases the probability of good health by 10 percentage points [95% CI 5–15], and eating vegetables every day increases the probability of good health by 4 percentage points [95% CI 0.2–7].

Conclusions

Exercise, smoking, social support and vegetable consumption are related to self-rated health 2000 and/or 2010.     

Theory-based predictors of influenza vaccination among pregnant women

Background

Guidelines recommend influenza vaccination for pregnant women, but vaccine uptake in this population is far below the goal set by Healthy People 2020. The purpose of this study was to examine predictors of seasonal influenza vaccination among pregnant women.

Methods

Between 2009 and 2012, the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) conducted a prospective cohort study of influenza vaccine safety among pregnant women in the US and Canada that oversampled vaccinated women. Data for the present paper are from an additional cross-sectional telephone survey completed during the 2010–2011 influenza season. We examined predictors of influenza vaccination, focusing on Health Belief Model (HBM) constructs.

Results

We surveyed 199 pregnant women, 81% of whom had received a seasonal influenza vaccine. Vaccination was more common among women who felt more susceptible to influenza (OR = 1.82, 95% CI 1.10–3.01), who perceived greater vaccine effectiveness (OR = 3.92, 95% CI 1.48–10.43), and whose doctors recommended they have flu shots (OR = 3.06, 95% CI 1.27–7.38). Those who perceived greater barriers of influenza vaccination had lower odds of vaccination (OR = 0.19, 95% CI 0.05–0.75). Perceived social norms, anticipated inaction regret, and worry also predicted uptake, though demographic characteristics of respondents did not.

Conclusion

The HBM provides a valuable framework for exploring influenza vaccination among pregnant women. Our results suggest several potential areas of intervention to improve vaccination rates.     

Mortality of induced abortion,other outpatient surgical procedures and common activities in the United States

Objective

The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities.

Methods

We calculated the abortion-related mortality rate during 2000–2009 using national data. We searched PubMed and other sources for contemporaneous data on mortality associated with other outpatient procedures commonly performed on healthy young women, marathon running, bicycling and driving.

Results

The abortion-related mortality rate in 2000–2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8–1.7 deaths per 100,000 plastic surgery procedures, 0–1.7deaths per 100,000 dental procedures, 0.6–1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007–2011 was about equal to the abortion-related mortality rate.

Conclusions

The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health.     

Pandemic influenza A(H1N1)pdm09 improves vaccination routine in subsequent years: A cohort study from 2009 to 2011

Background

In 2009 the pandemic influenza virus A(H1N1)pdm09 emerged with guidance that people at risk should be vaccinated. It is unclear how this event affected the underlying seasonal vaccination rate in subsequent years.

Purpose

To investigate the association of pandemic influenza A(H1N1)pdm09 and seasonal flu vaccination status in 2009 with vaccination rates in 2010 and 2011.

Methods

Data were collected in 40 Dutch family practices on patients at risk for influenza during 2009–2011; data analysis was conducted in 2012.

Results

A multilevel logistic regression model (n = 41,843 patients) adjusted for practice and patient characteristics (age and gender, as well as those patient groups at risk), showed that people who were vaccinated against A(H1N1)pdm09 in 2009 were more likely to have been vaccinated in 2010 (OR 6.02; 95%CI 5.62–6.45, p < .0001). This likelihood was even more for people who were vaccinated against seasonal flu in 2009 (OR 13.83; 95%CI 12.93–14.78, p < .0001). A second analysis on the uptake rate in 2011 (n = 39,468 patients) showed that the influence of the vaccination state in 2009 declined after two years, but the diminishing effect was smaller for people vaccinated against A(H1N1)pdm09 than for seasonal flu (OR 5.50; 95%CI 5.13–5.90, p < .0001; OR 10.98; 95%CI 10.26–11.75, p < .0001, respectively).

Conclusion

Being vaccinated against A(H1N1)pdm09 and seasonal influenza in the pandemic year 2009 enhanced the probability of vaccination in the next year and this was still effective in 2011. This suggests that peoples’ vaccination routines were not changed by the rumor around the outbreak of A(H1N1)pdm09, but rather confirmed underlying behavior.     

A multicentre randomized trial of combined individual and telephone counselling for smoking cessation

Objective

The present study assessed the effectiveness of smoking cessation programs combining individual and telephone counselling, compared to individual or telephone counselling alone.

Method

A randomized, multicentre, open-label trial was performed between January 2009 and July 2011 at six smoking cessation clinics in Spain. Of 772 smokers assessed for eligibility, 600 (77%) met inclusion criteria and were randomized. Smokers were randomized to receive individual counselling, combined telephone and individual counselling, or telephone counselling. The primary outcome was biochemically validated continuous abstinence at 52 weeks.

Results

The 52-week abstinence rate was significantly lower in the telephone group compared to the combined group (20.1% vs. 29.0%; OR, 1.32; 95% CI, 1.1–2.7) and to the individual counselling group (20.1% vs. 27.9%; OR, 1.37; 95% CI, 1.0–2.8). The 52-week abstinence rates were not significantly higher in the combined group than the individual group (OR, 0.97; 95% CI, 0.7–1.4).

Conclusion

Individual counselling and combined individual and telephone counselling were associated with higher 52-week abstinence rates than telephone counselling alone. A combined approach may be highly useful in the clinical treatment of smokers, as it involves less clinic visits than individual counselling alone, thus reducing the program cost, and it increases patient compliance compared to telephone counselling alone.     

Impact of 2 + 1 pneumococcal conjugate vaccine program in the province of Quebec,Canada

Background

Quebec was the first jurisdiction in the world to recommend a 3-dose (2 + 1) pneumococcal conjugate vaccine (PCV) schedule. The program was implemented in December 2004 with a catch-up for children <5 years. PCV-7 was first used and replaced, respectively, by PCV-10 in 2009 and by PCV-13 in 2011.

Methods

Cases of invasive pneumococcal disease (IPD) notified to public health authorities and isolates submitted to the provincial reference laboratory during the period 2000–2011 were analyzed.

Results

IPD incidence in children <5 years was 67/100,000 in 2001–2004, and decreased to 32/100,000 in 2007–2009 following PCV-7 implementation (p < 0.01). A further decrease to 24/100,000 was observed in 2010–2011 following PCV-10 introduction (p < 0.01). PCV-7 serotypes represented 82% of the total IPD cases in 2000–2004 and elimination was achieved in 2011. Main emerging serotypes were 19A and 7F. Children exposed to the PCV-10 experienced lower IPD rates and all serotypes contributed to the decline, mainly 7F and 19A. In adults, a decrease of low magnitude was observed in 2005–2006 but rates in 2007–2009 were higher than in the prevaccination period.

Conclusions

A 3-dose PCV schedule with high uptake is highly effective and should be recommended worldwide. Serotype replacement eroded benefits especially in adults. PCV-10 introduction had an effect and the impact of PCV-13 use remains to be evaluated.     

Effectiveness of influenza vaccination in elderly diabetic patients: A retrospective cohort study

Purpose

Studies regarding the clinical benefits of influenza vaccination in diabetic patients are limited. This study evaluated if the elderly diabetic patients who have had influenza vaccination would have benefits such as reduced medical care and mortality.

Methods

We used the universal insurance claims data from 2001 to 2009 in Taiwan to identify annual elderly patients with diabetes cohorts with (N = 4454) and without (N = 4571) influenza vaccination. The risk of developing pneumonia or influenza, respiratory failure, intensive care, hospitalization, and mortality were measured and compared between cohorts within one year of follow-up.

Results

The vaccine cohort had lower incidences of pneumonia or influenza and respiratory failure compared with the non-vaccine cohort. More importantly, the vaccine cohort had a hospitalization rate that was 11% less than the non-vaccine cohort (29.6 vs. 33.1 per 100 person-years) with an adjusted hazard ratio (HR) of 0.88 (95% CI 0.81–0.96). The vaccine cohort was also less likely to be admitted to the intensive care unit (ICU) [0.58 vs. 2.05 per 100 person-year; adjusted HR 0.30 (95% CI 0.19–0.47)] and less likely to expire [3.13 vs. 7.96 per 100 person-year; adjusted HR 0.44 (95% CI 0.36–0.54)]. Influenza vaccination reduced the hospitalization cost by 1282.6 USD, compared with patients without influenza vaccination (95% CI −2210.3, −354.8).

Conclusion

Influenza vaccination is associated with a reduced risk of morbidity, hospitalization, ICU admissions, and mortality. In addition, the hospitalization cost is reduced.     

Co-administration of live measles and yellow fever vaccines and inactivated pentavalent vaccines is associated with increased mortality compared with measles and yellow fever vaccines only. An observational study from Guinea-Bissau

Background

Studies from low-income countries indicate that co-administration of inactivated diphtheria–tetanus–pertussis (DTP) vaccine and live attenuated measles vaccine (MV) is associated with increased mortality compared with receiving MV only. Pentavalent (DTP–H. Influenza type B–Hepatitis B) vaccine is replacing DTP in many low-income countries and yellow fever vaccine (YF) has been introduced to be given together with MV. Pentavalent and YF vaccines were introduced in Guinea-Bissau in 2008. We investigated whether co-administration of pentavalent vaccine with MV and yellow fever vaccine has similar negative effects.

Methods

In 2007–2011, we conducted a randomised placebo-controlled trial of vitamin A at routine vaccination contacts among children aged 6–23 months in urban and rural Guinea-Bissau. In the present study, we included 2331 children randomised to placebo who received live vaccines only (MV or MV + YF) or a combination of live and inactivated vaccines (MV + DTP or MV + YF + pentavalent). Mortality was compared in Cox proportional hazards models stratified for urban/rural enrolment adjusted for age and unevenly distributed baseline factors.

Results

While DTP was still used 685 children received MV only and 358 MV + DTP; following the change in programme, 940 received MV + YF only and 348 MV + YF + pentavalent. During 6 months of follow-up, the adjusted mortality rate ratio (MRR) for co-administered live and inactivated vaccines compared with live vaccines only was 3.24 (1.20–8.73). For MV + YF + pentavalent compared with MV + YF only, the adjusted MRR was 7.73 (1.79–33.4).

Conclusion

In line with previous studies of DTP, the present results indicate that pentavalent vaccine co-administered with MV and YF is associated with increased mortality.