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Abstract
Objective We aimed to estimate the effectiveness of influenza and 23-valent pneumococcal polysaccharide vaccination on reducing the burden of community-acquired lower respiratory tract infection (LRTI) among older people with diabetes, and whether this varied by chronic kidney disease (CKD) status.
Research design and methods We used linked UK electronic health records for a retrospective cohort study of 190 492 patients ≥65 years with diabetes mellitus and no history of renal replacement therapy, 1997–2011. We included community-acquired LRTIs managed in primary or secondary care. Infection incidence rate ratios were estimated using the Poisson regression. Pneumococcal vaccine effectiveness (VE) was calculated as (1−effect measure). To estimate influenza VE, a ratio-of-ratios analysis (winter effectiveness/summer effectiveness) was used to address confounding by indication. Final VE estimates were stratified according to estimated glomerular filtration rate and proteinuria status.
Results Neither influenza nor pneumococcal vaccine uptake varied according to CKD status. Pneumococcal VE was 22% (95% CI 11% to 31%) against community-acquired pneumonia for the first year after vaccination, but was negligible after 5 years. In the ratio-of-ratios analysis, current influenza vaccination had 7% effectiveness for preventing community-acquired LRTI (95% CI 3 to 12). Pneumococcal VE was lower among patients with a history of proteinuria than among patients without proteinuria (p=0.04), but otherwise this study did not identify variation in pneumococcal or influenza VE by markers of CKD.
Conclusions The public health benefits of influenza vaccine may be modest among older people with diabetes. Pneumococcal vaccination protection against community-acquired pneumonia declines swiftly: alternative vaccination schedules should be investigated.
- Adult Diabetes
- Vaccine
- Chronic Kidney Disease
- Pneumococcal Infections
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Footnotes
A first draft of the manuscript was included in a PhD thesis by HIMD at the London School of Hygiene and Tropical Medicine in 2015, but not otherwise published previously in whole or part.
Contributors HIMD, SLT, and DN had the idea for the study and its design. HIMD carried out all analyses, using some analytic code provided by ERCM, and wrote the first draft of the manuscript, with input from SLT and DN. JQ contributed to interpretation of results and discussion. All authors contributed to this final manuscript and agreed to its submission. HIMD is the main guarantor of the content of this paper.
Funding This work was supported by National Institute for Health Research (grant number CDF 2010-03-32 to SLT) and Kidney Research UK (grant number ST2/2011 to HIMD). JQ was funded on an MRC Population Health Scientist Fellowship (grant number G0902135).
Disclaimer The study funders had no role in the design or conduct of the study, nor the collection, management, analysis nor interpretation of data, nor the preparation, review nor approval of the manuscript, nor the decision to submit it for publication. The views expressed in this publication are those of the authors and not necessarily those of the UK National Health Service, the National Institute for Health Research, the Department of Health, nor Kidney Research UK.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data that support the findings of this study were used under license and belong to the Clinical Practice Research Datalink, which can be contacted at https://www.cprd.com/intro.asp