The proportion of influenza vaccination in Ontario, Canada in 2007/2008 compared with other provinces
Highlights
► A higher seasonal immunization rate was observed in Ontario versus other provinces combined. ► Vaccination rate was linked with older age and having a chronic disease and a regular medical doctor. ► There was no association between immunization rate and socioeconomic status in Ontario.
Introduction
In Canada, seasonal influenza typically occurs during the fall and winter months [1]. According to the Public Health Agency of Canada, 5–15% of Canadians are affected by influenza annually. In addition, influenza is responsible for approximately 20,000 hospitalizations and between 2000 and 8000 deaths per year among Canadians due to complications [2]. The National Advisory Committee on Immunization encourages Canadians to protect themselves from the seasonal influenza through regular hand washing and flu shots [2]. Populations with specific chronic health conditions are recommended recipients of seasonal influenza immunization [3]. Some conditions include cardiac or pulmonary disorders, diabetes, cancer, renal disease, and asthma due to their high risk of influenza complications [4].
Free vaccines are available to seniors, individuals with chronic conditions and health care providers in most jurisdictions. In 2000, Ontario established a universal influenza immunization program (UIIP) to provide free influenza vaccines to its entire population aged six months or older [5]. Kwong et al. sought to measure the effect of the UIIP on influenza-associated mortality, hospitalizations, emergency department use, and visits to physicians’ offices in a 2008 study [6]. The results indicated that the universal program was associated with lower mortality and health care use compared with targeted immunization programs in other provinces. In Ontario, the immunization rate rose from 18% in 1996/97 to 35% in 2003, while the other provinces combined experienced an increase from 13% to 23% [7]. The vaccination rate in Ontario increased at a greater rate for populations between 12 and 65 years of age compared with other provinces. For populations 85 years or older, the vaccine uptake increased by a lesser degree in Ontario versus other provinces [7].
The primary research objective of this study was to compare the association between the 2007/2008 seasonal immunization rate in Ontario versus other provinces combined. Additional covariates, such as chronic disease status, age, gender, household income, smoking status, having a medical doctor, and self-perceived health status, were included in the analyses.
Section snippets
Materials and methods
Data collected from the 2007–2008 Canadian Community Health Survey (CCHS) (Cycle 4.1), a national cross-sectional survey conducted by Statistics Canada, were used in the analyses [8]. The survey was administered to Canadians aged 12 years or older and who were living in private dwellings in Canada. Individuals, who were living on Indian reserves, in institutions, or in certain remote areas, who were homeless or a full-time member of the Canadian Armed Forces were excluded from the survey
Results
Table 1 presents the selected demographic characteristics of the survey respondents, and the results were weighted to the Canadian population. In 2007/2008, 39.0% of the population resided in Ontario. Around 20% of Canadians had at least one chronic disease, and 15% of respondents did not have a regular medical doctor. The proportion of males and females was equally distributed (49.3% versus 51.7%). As seen in Table 1, 41.2% of Canadians never smoked versus 37.9% of former smokers and 21.6% of
Discussion
This study sought to estimate the relationship between the 2007/2008 influenza immunization rate and province of residence. Province of residence was categorized by Ontario and other provinces combined. Covariates, such as chronic disease status, gender, age, income, having a regular medical doctor, smoking status, and self-perceived health status, were included in the analysis. Kwong et al. previously identified trends of influenza vaccination in Canada using health survey data from 1996/1997,
Conclusions
To summarize, Ontario was associated with higher seasonal influenza vaccination compared with other provinces combined. The results also suggested that increased age, having a chronic disease and having a regular medical doctor were significant predictors of immunization vaccination in 2007/2008. A positive chronic disease status, increased age and high income had less of an impact on the 2007/2008 vaccination rate in Ontario than in other provinces, and the UIIP may be the reason. The study
Acknowledgement
The authors would like to thank Dr. Jeff Kwong for his valuable comments to the draft manuscript.
Contributors: Julie Polisena was the project lead and prepared the manuscript. Drs. Yue Chen and Douglas Manuel contributed to the preparation of the manuscript and provided feedback on the draft versions.
Conflicts of interest: None declared.
Funding: None.
References (18)
- et al.
Chronic disease status, self-perceived health and hospital admissions are important predictor for having a flu shot in Canada
Vaccine
(2007) - et al.
Influenza vaccination rates in Ontario children: implications for universal childhood vaccination policy
Vaccine
(2009) - et al.
Validation of self-reported chronic conditions and health services in a managed care population
American Journal of Preventive Medicine
(2000) - et al.
Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients
American Journal of Preventive Medicine
(1999) - et al.
Does a population survey provide reliable influenza vaccine uptake rates among high-risk groups? A case-study of The Netherlands
Vaccine
(2004) - Understanding pandemic influenza [Internet]. Ottawa: Public Health Agency of Canada; 2008. Available from:...
- Seasonal flu shot [Internet]. Ottawa: Public Health Agency of Canada. Available from...
- Statement on influenza vaccination for the 2007–2008 season. Canada Communicable Disease Report, Vol. 33, ASC-7, July...
- et al.
Influenza vaccination
Health Reports
(2004)
Cited by (9)
Shades of gray in vaccination decisions – Understanding community pharmacists’ perspectives of, and experiences with, influenza vaccine hesitancy in Ontario, Canada
2020, VaccineCitation Excerpt :As such, it is essential to consider the impact of multiple influences and the importance of context when estimating the cause for hesitancy. Despite such complexity, healthcare providers – through their standing as trusted sources of health information – remain the strongest influencers of vaccination decisions [5,11–13]. The impact of physician, nurse, and pharmacist recommendations on vaccine uptake has been well documented [14–21].
Impact of pharmacist administration of influenza vaccines on uptake in Canada
2017, CMAJCitation Excerpt :Finally, our study relied on self-report of influenza vaccination status within the 12 months before survey participation, which may be susceptible to reporting biases. However, self-report of influenza vaccination has been shown to be valid36–39 and has been used previously to estimate vaccine coverage.23,40,41 The presence of a policy allowing pharmacists to administer publicly funded seasonal influenza vaccines was associated with modest increases in vaccine uptake.
Determinants of non-vaccination against seasonal influenza in Canadian adults: findings from the 2015–2016 Influenza Immunization Coverage Survey
2018, Canadian Journal of Public HealthDeterminants of non-vaccination against seasonal influenza
2018, Health Reports