Neighborhood determinants of 2009 pandemic A/H1N1 influenza vaccination in Montreal, Quebec, Canada.

Neighborhood-level analyses of influenza vaccination can identify the characteristics of vulnerable neighborhoods, which can inform public health strategy for future pandemics. In this study, the authors analyzed rates of 2009 pandemic A/H1N1 influenza vaccination in Montreal, Quebec, Canada, using individual-level vaccination records from a vaccination registry with census, survey, and administrative data to estimate the population at risk. The neighborhood socioeconomic and demographic determinants of vaccination were identified using Bayesian ecologic logistic regression, with random effects to account for spatial autocorrelation. A total of 918,773 (49.9%) Montreal residents were vaccinated against pandemic A/H1N1 influenza from October 22, 2009, through April 8, 2010. Coverage was greatest among females, children under age 5 years, and health-care workers. Neighborhood vaccine coverage ranged from 33.6% to 71.0%. Neighborhoods with high percentages of immigrants (per 5% increase, odds ratio = 0.90, 95% credible interval: 0.86, 0.95) and material deprivation (per 1-unit increase in deprivation score, odds ratio = 0.93, 95% credible interval: 0.88, 0.98) had lower vaccine coverage. Half of the Montreal population was vaccinated; however, considerable heterogeneity in coverage was observed between neighborhoods and subgroups. In future vaccination campaigns, neighborhoods that are materially deprived or have high percentages of immigrants may benefit from focused interventions.