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Title: Patterns of influenza vaccination coverage in the United States from 2009 to 2015
Authors: Chiu, APY 
Dushoff, J
Yu, D
He, D 
Keywords: Ecological study
Mixed model
Vaccination coverage
Issue Date: 2017
Publisher: Elsevier B.V.
Source: International journal of infectious diseases, 2017, v. 65, p. 122-127 How to cite?
Journal: International journal of infectious diseases 
Abstract: Background Globally, influenza is a major cause of morbidity, hospitalization and mortality. Influenza vaccination has shown substantial protective effectiveness in the United States. Methods We investigated state-level patterns of coverage rates of seasonal and pandemic influenza vaccination, among the overall population (six months or older) in the U.S. and specifically among children (aged between 6 months and 17 years) and the elderly (aged 65 years or older), from 2009/10 to 2014/15, and associations with ecological factors. We obtained state-level influenza vaccination rates from national surveys, and state-level socio-demographic and health data from a variety of sources. We employed a retrospective ecological study design, and used both linear models and linear mixed-effect models to determine the levels of ecological association of the state-level vaccinations rates with these factors, both with and without region as a factor for the three populations. Results and Conclusions Health-care access has a robust, positive association with state-level vaccination rates across all populations and models. This highlights a potential population-level advantage of expanding health-care access. We also found that prevalence of asthma in adults is negatively associated with mean influenza vaccination rates in the elderly populations.
ISSN: 1201-9712
DOI: 10.1016/j.ijid.2017.10.004
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