The Association Of Influenza Vaccine And Health Risks With Specific Cardiovascular Diseases And Management Strategy

ObjectiveInfluenza is a type of acute respiratory infectious disease caused by influenza virus,which can cause multiple system risks and cardiovascular system damage in patients,and can lead to death.Influenza vaccination can reduce the incidence of influenza and effectively reduce the adverse health outcomes caused by influenza.Currently,influenza vaccination rates vary greatly among countries around the world,for example,the influenza vaccination rate in the United Kingdom and the Netherlands has reached 75%,while the vaccination rate of China is less than 3%.The low rate of influenza vaccine results in a much higher disease burden of influenza and related adverse health outcomes in China than in western countries.Therefore,it is of great significance to increase the influenza vaccination rate of Chinese residents and reduce the burden of influenza and its adverse health outcomes.In this study,we first explored the relationship between influenza vaccination and different health outcomes worldwide through systematic review method,and evaluated the impact of influenza vaccination on adverse health outcomes in Chinese adult population based on retrospective cohort study data.Second,based on systematic reviews,the health economic benefits of influenza vaccination on a global scale are explored,and a health economic model of influenza vaccination is constructed to evaluate and predict the health effectiveness and cost-effectiveness of influenza vaccination in China against influenza and its complications.Third,taking Tianjin as an example to conduct a questionnaire survey to analyze the status quo of knowledge,belief and practice of influenza vaccines among adults.Methods1.The effects of influenza vaccination on different health outcomes were explored using systematic analysis and retrospective nested case-control studies.Systematic analysis of the association between influenza vaccination and different health outcomes;univariate and multivariate Logistic regression models were established to explore the effects of influenza vaccination on adverse health outcomes in adult population in Tianjin.Population-attributed scores were calculated to analyze the proportion of influenza vaccination in the adult population that reduced adverse health outcomes and specific cardiovascular risks;The number of people who would need to be vaccinated against influenza to reduce an adverse health event and cardiovascular event by number needed to treat;The mediating effect of hypertension on the association between influenza vaccination and cardiovascular disease was analyzed using Baron & Kenny’s mediating effect causal step method and weighted logistic regression model.2.Health economics of influenza vaccination was evaluated by systematic reviews and a health economics model was constructed.Systematic analysis of different influenza vaccination strategies,the health effectiveness and cost-effectiveness of influenza vaccination among different populations;Based on domestic statistics and literature data,model parameters suitable for China’s national conditions were selected to construct a Markov transfer model to evaluate the health efficacy and cost-effectiveness of influenza vaccination in adult population of China against influenza and related complications;The health effects and cost-effectiveness of influenza vaccination in different age groups were predicted by setting different influenza vaccination rates.3.Influenza vaccination questionnaire was designed by ourselves to investigate and analyze the knowledge,belief and practice of influenza vaccination among adult population in China and the influencing factors.In Tianjin,for example,randomly selected from 6 in the city zone 2 boroughs,randomly selected from 4 areas around 1boroughs,each of which randomly 1 hospital/community health service centers,with convenience sampling method for the adult population,the questionnaire survey to explore and cardiovascular disease in the general population,the known nobuyuki status of influenza vaccination,Univariate and multivariate Logistic regression models were used to analyze the influencing factors of influenza vaccination.Results1.A total of 75 studies covering 4.419,700 samples from 18 countries from1999 to 2018 were systematically analyzed.Systemic analysis showed that influenza vaccination had a protective effect on different health outcomes,reducing the risk of all-cause death by 43%(OR=57%,95%CI =0.51-0.63)and cardiovascular disease by26%(OR=74%,95%CI =0.70-0.78).The retrospective nest-controlled case-control study further showed that influenza vaccination significantly reduced adverse health outcomes and specific risks for cardiovascular disease,after adjusting for age,sex,education,income,healthy lifestyle,hypertension,and diabetes.Influenza vaccination was associated with a 45%(OR=0.55,95%CI=0.35 to 0.85)reduction in adverse health outcomes and a 49%(OR=0.51,95%CI=0.30 to 0.89)reduction in specific risk of cardiovascular disease.Adjusted for multiple factors,influenza vaccination reduced adverse health outcomes by 34.5%(95%CI =8.7%-52.9%)and incidence of cardiovascular disease by 38.6%(95%CI =5.5%-60.2%)in the population.NNT results show that at least 14 and 20 people need to be vaccinated against influenza to prevent an adverse health outcome event and a cardiovascular event.Mediating effect analysis found that hypertension was a mediating variable,with a mediating effect accounting for 17.0%(95%CI: 6.9%-39.8%)of the total effect.2.The results of a systematic review of 45 studies from 17 countries/regions during 2015-2020 show that different influenza vaccination strategies are cost-effective for different age groups.The results of the Markov model showed that compared with the non-vaccinated influenza vaccine,the vaccinated trivalent influenza vaccine(TIV)and quadrivalent influenza vaccine(Quadrivalent influenza vaccine)were significantly higher than those of the non-vaccinated influenza vaccine,increased by 0.0377 and 0.0187quality-adjusted life years(QALY)per capita.Incremental cost-effectiveness ratio(QALY)ICER were ￥-11837.65/QALY and￥-6791.45/QALY,respectively,indicating that influenza vaccination was cost-effective.Comparison of different vaccination strategies for influenza vaccine showed that the cost of TIV vaccination was lower than that of QIV(the lifetime cost per capita was ￥12436.98 and ￥12756.90,respectively),and the cost-effectiveness of TIV vaccination was higher than that of QIV.The prediction results of the health economics model show that the higher the vaccination rate,the older the vaccinated population,and the higher the cost effectiveness.When the vaccination rate was 10%,TIV and QIV could increase QALY by 0.0349 and 0.0406 individuals per capita,and ICER was￥-11842.53/QALY and ￥-6764.20/QALY,respectively.When the vaccination rate was 80%,TIV and QIV could increase QALY by 0.2964 and 0.3477 per capita,and ICER was ￥-11307.47 /QALY and ￥-6426.87/QALY,respectively.Inoculating TIV and QIV could increase 0.0378 and 0.0187 QALY in 18 to 24 years old population,and the ICER was ￥-11836.13 /QALY and ￥-6789.66/QALY,respectively.Inoculation of TIV and QIV could increase 0.2405 and 0.1181 QALY,and ICER was ￥-1303.22 /QALY and ￥-747.85/QALY,respectively..3.The results of the questionnaire survey showed that the awareness rate of the subjects about influenza was 62.92%,and the awareness rate of influenza vaccine was only 33.24%.Young age,high education level,never drinking alcohol,and healthy diet were the factors that promoted the cognition of influenza and influenza vaccine.55.58% of the population had a positive attitude towards influenza and influenza vaccine,and 44.42% had a negative attitude towards influenza.Women,other ethnic groups,people with high annual family income,personal history of disease,and people with high exercise intensity(MET)were more likely to have a positive attitude towards influenza and influenza vaccine.The intention rate of influenza vaccine vaccination was 40.29%,and the intention of influenza vaccine vaccination was higher among people who were younger,had higher household income,had a history of personal illness,and were current smokers/former smokers.Single factor Logistic regression analysis results showed that age,culture level,occupation,family income,family history,personal history of disease,smoking and secondhand smoke exposure,drinking,MET,influenza vaccine cognitive score,flu and influenza vaccine cognitive total score evaluation,behavior,belief is the important factors influencing the influenza vaccination(P < 0.05),Multivariate regression analysis showed that male,high annual household income,personal history of disease,no exposure to secondhand smoke,never drinking alcohol,low diet score,high influenza vaccine cognition level,and high influenza vaccine behavior score were independent influencing factors for influenza vaccination(P <0.05)..ConclusionFirst,influenza vaccination can significantly reduce different health risks,cardiovascular disease-specific risks,and all-cause mortality risks,and can be used as an effective measure to prevent adverse health outcomes and reduce cardiovascular disease-specific risks and mortality.Second,influenza vaccination has a good health effect and health economic benefits on influenza and related complications,and vaccination rate should be further improved to reduce the related treatment costs caused by influenza and improve the health effect.Third,knowledge and practice of influenza vaccine is an important factor affecting the coverage rate of influenza vaccine.The level of KAP of influenza vaccine among adult population in China needs to be improved,which directly affects the improvement of the coverage rate of influenza vaccine,greatly affects the situation of influenza prevention and control in China,and increases the risk of influenza complications and death as well as the economic cost.Based on the above discussion,real data and evidence can be obtained to continuously expand the research on the effects of influenza vaccination and the health economic benefits.We will improve the system for influenza vaccination and promote policies that benefit the people,such as free vaccination.To expand publicity efforts and coverage to enhance the awareness and trust of the population on influenza vaccine.To ensure the safety and effectiveness of influenza vaccines,accelerate the approval of new vaccines on the market,and comprehensively increase the population coverage of influenza vaccines..