Factors influencing acceptance of influenza and pneumococcal vaccinations for patients with chronic obstructive pulmonary disease

Figures & data

Figure 1. Flowchart of COPD patient recruitment to the study.

Table 1. Baseline characteristics of patients with chronic obstructive pulmonary disease.

Characteristics	N = 134
Age, years	75.40 ± 8.71
Male	122 (91.0)
BMI, kg/m^2	22.58 ± 4.20
Ex-smoking	122 (91.0)
Smoking, pack-years	27.27 ± 20.08
Comorbidity
Hypertension	84 (62.7)
Diabetes	34 (25.4)
Heart disease	34 (25.4)
Renal disease	12 (9.0)
Stroke	7 (5.2)
Liver disease	4 (3.0)
Lung disease	4 (3.0)
Pneumococcal vaccination	59 (44.0)
PCV13	57 (42.5)
PPSV23	35 (26.1)
Influenza vaccination	102 (76.1)
Physician
Pulmonologists	83 (61.9)
Internists	51 (38.1)
Exacerbation in the past year, events	1.20 ± 2.74
Hospitalization in the past year, events	0.65 ± 1.74
Spirometry data
Post-BD FVC, L	2.48 ± 0.72
Post-BD FVC, % predicted	82.74 ± 20.72
Post-BD FEV1, L	1.42 ± 0.53
Post-BD FEV1, %predicted	65.05 ± 25.21
FEV1 change after BD, %	7.14 ± 10.65
Pre-BD FEV1/FVC, %	56.92 ± 12.72
Post-BD FEV1/FVC, %	56.74 ± 12.27
Functional performance
mMRC, points	1.85 ± 1.20
CAT score, points	9.51 ± 6.96

Data shown as mean ± SD or n (%).

BD = bronchodilator, BMI=body mass index, CAT=COPD assessment test, FEV₁ = forced expiratory volume in 1 second, FVC = forced vital capacity, kg = kilograms, L = liters, m = meters, mMRC = modified Medical Research Council, PCV13 = 13-valent pneumococcal conjugate vaccine, PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

Table 2. Comparison of associated factors between influenza vaccinated group and non-vaccinated group in patients with chronic obstructive pulmonary disease.

Characteristics	Influenza vaccination		P-value
	Vaccinated (n = 102)	Unvaccinated (n  = 32)
Age, years	75.44 ± 8.85	75.25 ± 8.38	.914
Male	92 (90.2)	30 (93.8)	.730
Ex-smoking	95 (93.1)	27 (84.4)	.157
Smoking, pack-years	27.66 ± 20.52	26.04 ± 18.90	.692
Comorbidity
Hypertension	66 (64.7)	18 (56.3)	.338
Diabetes	27 (26.5)	7 (21.9)	.602
Heart disease	30 (29.4)	4 (12.5)	.055
Renal disease	11 (10.8)	1 (3.1)	.292
Lung disease	4 (3.9)	0 (0)	.572
Pneumococcal vaccination	59 (57.8)	0 (0)	<.001
PCV13	57 (55.9)	0 (0)	<.001
PPSV23	35 (34.3)	0 (0)	<.001
Physician
Pulmonologist	73 (71.6)	10 (31.3)	<.001
Internist	29 (28.4)	22 (68.8)
Exacerbation, events	1.31 ± 3.05	0.84 ± 1.30	.399
Hospitalization, events	0.72 ± 1.90	0.44 ± 1.13	.433
Spirometry data
Post-BD FVC, L	2.44 ± 0.73	2.61 ± 0.67	.302
Post-BD FVC, % predicted	81.87 ± 21.15	85.85 ± 19.17	.389
Post-BD FEV1, L	1.41 ± 0.53	1.46 ± 0.54	.728
Post-BD FEV1, %predicted	64.99 ± 25.97	65.25 ± 22.73	.962
FEV1 change after BD, %	8.29 ± 11.24	3.57 ± 7.64	.029
Pre-BD FEV1/FVC, %	57.00 ± 12.83	56.67 ± 12.57	.904
Post-BD FEV1/FVC, %	57.28 ± 12.51	54.78 ± 11.38	.360
Functional performance
mMRC, points	1.83 ± 1.20	1.91 ± 1.23	.766
CAT score, points	9.56 ± 6.92	9.34 ± 7.18	.879

Data shown as mean ± SD or n (%).

BD = bronchodilator, CAT = COPD assessment test, FEV₁ = forced expiratory volume in 1 second, FVC = forced vital capacity, L = liters, mMRC = modified Medical Research Council, PCV13 = 13-valent pneumococcal conjugate vaccine, PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

Table 3. Comparison of associated factors between pneumococcal vaccinated group and non-vaccinated group in patients with chronic obstructive pulmonary disease.

Characteristics	Pneumococcal vaccination		P-value
	Vaccinated (n = 59)	Unvaccinated (n = 75)
Age, years	77.00 ± 9.35	74.13 ± 8.00	.058
Male	56 (94.9)	66 (88.0)	.164
Ex-smoking	54 (91.5)	68 (90.7)	.863
Smoking, pack-years	27.82 ± 19.42	26.84 ± 20.72	.781
Comorbidity
Hypertension	40 (67.8)	44 (58.7)	.278
Diabetes	18 (30.5)	16 (21.3)	.226
Heart disease	23 (39.0)	11 (14.7)	.001
Renal disease	8 (13.6)	4 (5.3)	.098
Lung disease	4 (6.8)	0 (0)	.035
Influenza vaccination	59 (100.0)	43 (57.3)	<.001
Physician
Pulmonologist	54 (91.5)	29 (38.7)	<.001
Internist	5 (8.5)	46 (61.3)
Exacerbation, events	1.51 ± 2.82	0.96 ± 2.66	.251
Hospitalization, events	0.76 ± 1.72	0.56 ± 1.77	.506
Spirometry data
Post-BD FVC, L	2.35 ± 0.74	2.50 ± 0.69	.076
Post-BD FVC, % predicted	78.41 ± 22.16	86.34 ± 18.87	.037
Post-BD FEV1, L	1.30 ± 0.48	1.52 ± 0.55	.024
Post-BD FEV1, %predicted	60.89 ± 28.71	68.57 ± 21.41	.096
FEV1 change after BD, %	8.66 ± 12.69	5.92 ± 8.56	.142
Pre-BD FEV1/FVC, %	54.22 ± 12.96	59.00 ± 12.22	.037
Post-BD FEV1/FVC, %	54.87 ± 12.08	58.27 ± 1.53	.148
Functional performance
mMRC, points	2.08 ± 1.12	1.67 ± 1.25	.046
CAT score, points	10.32 ± 6.14	8.87 ± 7.52	.231

Data shown as mean ± SD or n (%).

BD = bronchodilator, CAT = COPD assessment test, FEV₁ = forced expiratory volume in 1 second, FVC = forced vital capacity, L = liters, mMRC=modified Medical Research Council, PCV13 = 13-valent pneumococcal conjugate vaccine, PPSV23 = 23-valent pneumococcal polysaccharide vaccine.

Table 4. Logistic regression analysis of factors associated with influenza and pneumococcal vaccination in patients with chronic obstructive pulmonary disease.

Factors	OR	95% CI	P-value
Influenza vaccination
Pneumococcal vaccination	923.10	0.01–1,032.73	.997
Pulmonologist	1.74	0.64–4.68	.276
Every 1% increase in FEV1 after BD test	1.07	1.01–1.14	.045
Pneumococcal vaccination
Heart disease	1.74	0.47–6.51	.409
Lung disease	5,674.01	0.01–12,047.37	.999
Influenza vaccination	2,828.37	0.01–8,666.96	.997
Pulmonologist	23.22	5.36–100.51	<.001
Every 1% predicted increase in post-BD FVC	0.99	0.96–1.02	.525
Every 1 L increase in post-BD FEV1	0.87	0.15–4.94	.871
Every 1% increase in pre-BD FEV1/FVC	0.95	0.89–1.01	.075
Every 1 unit increase in mMRC	1.43	0.83–2.46	.195

BD = bronchodilator, CI = confidence interval, FEV₁ = forced expiratory volume in 1 second, FVC = forced vital capacity, L = liters, mMRC = modified Medical Research Council, OR = odds ratio.

Table 5. Reasons for no vaccination in patients with chronic obstructive pulmonary disease.

Reasons	No influenza vaccination (n = 32)	No pneumococcal vaccination (n = 75)
Doctors did not advise it	26 (81.3)	69 (92.0)
I didn’t know I had to be vaccinated	22 (68.8)	64 (85.3)
I didn’t know when I get it	19 (59.4)	53 (70.7)
I didn’t know how to access it	16 (50.0)	45 (60.0)
I am not in a risk group	6 (18.8)	13 (17.3)
Vaccine is too expensive	3 (9.4)	14 (18.7)
I’m not sure why we should vaccinate	3 (9.4)	1 (1.3)
I think it is not safe	2 (6.3)	3 (4.0)
I fear to ask a doctor	2 (6.3)	2 (2.7)
I think COPD can be treated with medication	2 (6.3)	2 (2.7)
I worry about getting fever after vaccination	2 (6.3)	1 (1.3)
I am afraid of needles	1 (3.1)	2 (2.7)
It has a lot of processes	2 (6.3)	0 (0)
I have contraindication	0 (0)	1 (1.3)

Data shown as n (%).

COPD=chronic obstructive pulmonary disease.

Table 6. Reasons for vaccinations in patients with chronic obstructive pulmonary disease.

Reasons	Influenza vaccination (n = 102)	Pneumococcal vaccination (n = 59)
Doctor recommended	91 (89.2)	58 (98.3)
I know it from a friend’s advice	25 (24.5)	2 (3.4)
I know it from a poster	19 (18.6)	1 (1.7)
I know it from television	17 (16.7)	1 (1.7)
I know it from the internet	5 (4.9)	1 (1.7)
I asked my doctor to prevent exacerbation	4 (3.9)	0 (0)
I asked a doctor how to get better from disease	4 (3.9)	0 (0)
I worry about disease, so I got advice from a doctor	1 (1.0)	0 (0)

Data shown as n (%).