I-Kuan Wang1, Cheng-Li Lin2, Po-Chang Lin3, Shih-Ni Chang4, Che-Yi Chou5, Tzung-Hai Yen6, Chiz-Tzung Chang5, Chiu-Ching Huang5, Fung-Chang Sung7. 1. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan. 2. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan. 3. Division of Infection, China Medical University Hospital, Taichung, Taiwan. 4. Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan. 5. Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan. 6. Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan Chang Gung University College of Medicine, Taoyuan, Taiwan. 7. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Abstract
BACKGROUND: Studies on the effectiveness of seasonal influenza vaccination in peritoneal dialysis (PD) patients are limited. The aim of the present study is to evaluate the effectiveness of seasonal influenza vaccination in reducing morbidity and mortality in incident end-stage renal disease patients on PD. METHODS: From Taiwan's National Health Insurance Research Database, we identified 2089 incident PD patients with seasonal influenza vaccination and 2089 propensity score matched incident PD patients without the vaccination during 1998-2010. Each study subject was followed up to measure the 12-month incident cardiovascular and infectious diseases, and deaths. The effects of multi-year vaccinations were also estimated. RESULTS: Compared with the non-vaccinated cohort, the vaccinated cohort had a lower hospitalization rate (68.5 versus 80.2 per 100 person-years) with an adjusted hazard ratio (aHR) of 0.85 [95% confidence interval (CI) = 0.78-0.92]. Hazards of hospitalization were significantly reduced for sepsis (aHR = 0.79, 95% CI = 0.65-0.96), heart disease (aHR = 0.74, 95% CI = 0.63-0.89) and intensive care (aHR = 0.85, 95% CI = 0.73-0.99). In addition, hazards of peritonitis (aHR = 0.84, 95% CI = 0.73-0.97) and overall mortality (aHR = 0.66, 95% CI = 0.55-0.78) were also reduced. The aHR of mortality was reduced much further to 0.28 (95% CI = 0.22-0.35) for those with multiple-year vaccinations. CONCLUSIONS: Seasonal influenza vaccination for PD patients is associated with significant reduction in morbidities and a 34% reduction in mortality. Multi-year vaccinations could reduce the death hazard further to 72%.
BACKGROUND: Studies on the effectiveness of seasonal influenza vaccination in peritoneal dialysis (PD) patients are limited. The aim of the present study is to evaluate the effectiveness of seasonal influenza vaccination in reducing morbidity and mortality in incident end-stage renal diseasepatients on PD. METHODS: From Taiwan's National Health Insurance Research Database, we identified 2089 incident PDpatients with seasonal influenza vaccination and 2089 propensity score matched incident PDpatients without the vaccination during 1998-2010. Each study subject was followed up to measure the 12-month incident cardiovascular and infectious diseases, and deaths. The effects of multi-year vaccinations were also estimated. RESULTS: Compared with the non-vaccinated cohort, the vaccinated cohort had a lower hospitalization rate (68.5 versus 80.2 per 100 person-years) with an adjusted hazard ratio (aHR) of 0.85 [95% confidence interval (CI) = 0.78-0.92]. Hazards of hospitalization were significantly reduced for sepsis (aHR = 0.79, 95% CI = 0.65-0.96), heart disease (aHR = 0.74, 95% CI = 0.63-0.89) and intensive care (aHR = 0.85, 95% CI = 0.73-0.99). In addition, hazards of peritonitis (aHR = 0.84, 95% CI = 0.73-0.97) and overall mortality (aHR = 0.66, 95% CI = 0.55-0.78) were also reduced. The aHR of mortality was reduced much further to 0.28 (95% CI = 0.22-0.35) for those with multiple-year vaccinations. CONCLUSIONS: Seasonal influenza vaccination for PDpatients is associated with significant reduction in morbidities and a 34% reduction in mortality. Multi-year vaccinations could reduce the death hazard further to 72%.