Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2016

Open Access 01-12-2016 | Research

Who benefits most from influenza vaccination policy: a study among the elderly in Beijing, China

Authors: Tongtong Li, Min Lv, Trudy Lei, Jiang Wu, Xinghuo Pang, Ying Deng, Zheng Xie

Published in: International Journal for Equity in Health | Issue 1/2016

Login to get access

Abstract

Background

Influenza continues to have a major impact on vulnerable populations worldwide, particularly among the elderly (≥60 years of age). Vaccination for targeted groups is recommended by the WHO as the most effective way to control influenza infections. Since 2009, the Beijing municipal government has provided influenza vaccination to the elderly at no out-of-pocket cost to reduce influenza threats and improve related health equality. The study aims to evaluate the equality of the policy, and to analyze factors that bring influences to equality.

Methods

Based on data from a household survey, concentration index (CI) was calculated to measure the socioeconomic inequality in influenza vaccination. A Logit regression model was used to decompose CI, in which the contribution of each determinant was calculated and the percentages of these contribution were obtained.

Results

Free influenza vaccination at point of use shows significant pro-poor distribution among the elderly in Beijing (CI = −0.115). After the decomposition of CI, the elderly with lower income, higher education, and living in rural areas were more likely to get the influenza vaccination, in which place of residence (contribution percentage = 57 %) held the most contribution of variance.

Conclusions

Beijing’s free influenza vaccination strategy at point of use could provide the poor elderly with equal opportunities to receive preventive health service, showing a significant pro-poor distribution. The poor elderly, who live in rural areas with high education, benefit most from the policy. Further policy interventions should target the population living in urban areas in order to improve the utilization of public health services and health equality.
Literature
1.
Glezen WP. Prevention and Treatment of Seasonal Influenza. N Engl J Med. 2008;359(24):2579-85.
2.
Monto AS, Ansaldi F, Aspinall R, Mcelhaney JE, Monta OLF, Nichol KL, et al. Influenza control in the 21st century: optimizing protection of older adults. Vaccine. 2009;27(37):5043–53.CrossRefPubMed
3.
Sun Q, Liu X, Meng Q, Tang S, Yu B, Tolhurst R. Evaluating the financial protection of patients with chronic disease by health insurance in rural China. Int J Equity Health. 2009;8(28):3567–79.
4.
Alhammadi A, Khalifa M, Abdulrahman H, Almuslemani E, Alhothi A, Janahi M. Attitudes and perceptions among the pediatric health care providers toward influenza vaccination in Qatar: A cross-sectional study. Vaccine. 2015;33:3821–8.CrossRefPubMed
5.
Fiore AE, Uyeki TM, Broder K, Finelli L, Euler GL, Singleton JA, et al. Prevention and Control Of Influenza With Vaccines: Recommendations Of The Advisory Committee On Immunization Practices (Acip), 2010. MMWR Recomm Rep. 2010;59(30):1–62.PubMed
6.
7.
Dexter LJ, Teare MD, Dexter M, Siriwardena AN, Read RC. Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice. BMJ Open. 2012;2(3):e000851.CrossRefPubMedPubMedCentral
8.
Ng S, Wu P, Nishiura H, Ip D, Lee E, Cowling B. An analysis of target recipient groups for monovalent 2009 pandemic influenza vaccine and trivalent seasonal influenza vaccines in 2009-10 and 2010-11. Eswi Influenza Conference Abstract Book. 2011;11(9):230.
9.
Pengjun L, Bridges CB, Euler G, Singleton JA. Influenza vaccination of recommended adult populations, U.S., 1989-2005. Vaccine. 2008;26(14):1786–93.CrossRef
10.
Polisena J, Yue C, Manuel D. The proportion of influenza vaccination in Ontario, Canada in 2007/2008 compared with other provinces. Vaccine. 2012;30(11):1981–5.CrossRefPubMed
11.
Siyan Y, Daisuke N, Marino N, Jun K, Tetsuya M. Predictors of the Uptake of A (H1N1) Influenza Vaccine: Findings from a Population-Based Longitudinal Study in Tokyo. PLoS One. 2011;6(4):1712.
12.
Blank P, Schwenkglenks M, Szucs TD. The impact of European vaccination policies on seasonal influenza vaccination coverage rates in the elderly. Hum Vacc Immunother. 2012;8(3):328–35.CrossRef
13.
Van Doorslaer E, Wagstaff A, Bleichrodt H, Calonge S, Gerdtham U, Gerfin M, et al. Income-related inequalities in health: some international comparisons. J Health Econ. 1997;16(1):93–112.CrossRefPubMed
14.
Wagstaff A, Van Doorslaer E, Van der Burg H, Calonge S, Christiansen T, Citoni G, et al. Equity in the finance of health care: some further international comparisons. J Health Econ. 1999;18(3):263–90.CrossRefPubMed
15.
Van Doorslaer E, Masseria C, Koolman X. Inequalities in access to medical care by income in developed countries. Can Med Assoc J. 2006;174(2):177–83.CrossRef
16.
Zhou Z, Gao J, Fox A, Rao K, Ke X, Ling X, et al. Measuring the equity of inpatient utilization in Chinese rural areas. BMC Health Serv Res. 2011;11(5):697–9.
17.
18.
Embrett MG, Randall GE. Social determinants of health and health equity policy research: exploring the use, misuse, and nonuse of policy analysis theory. Soc Sci Med. 2014;108(4):147–55.CrossRefPubMed
19.
Andre FE, Booy R, Bock HL, Clemens J, Datta SK, John TJ, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. B World Health Organ. 2008;86(2):140–6.CrossRef
20.
Kwong EWY, Lam IOY, Chan TMF. What factors affect influenza vaccine uptake among community-dwelling older Chinese people in Hong Kong general outpatient clinics? J Clin Nurs. 2009;18(7):960–71.CrossRefPubMed
21.
Lei Z, Qiru S, Zhen X, Ao F, Hui J, Shiyuan W, et al. Seasonal influenza vaccination coverage rate of target groups in selected cities and provinces in China by season (2009/10 to 2011/12). PLoS One. 2013;8(2):237–9.CrossRef
22.
Li HY, Wu SS, Yang P, Zhang Y, Ma CN, Li XY, et al. Influenza vaccination coverage rates and factors associated with vaccine use among the elderly in Beijing during 2008-2010. Chinese J Epi. 2012;33(2):247–8.
23.
Wu S, Peng Y, Li H, Ma C, Yi Z, Wang Q. Influenza vaccination coverage rates among adults before and after the 2009 influenza pandemic and the reasons for non-vaccination in Beijing, China: A cross-sectional study. BMC Public Health. 2013;13(15):2681–94.
24.
25.
Mendelson J. PPSCHROMY: Stata module to draw sample with probability proportionate to size, using Chromy’s method of sequential random sampling. Boston College Department of Economics. United States. 2014.
26.
Wagstaff A, van Doorslaer E. Measuring and testing for inequity in the delivery of health care. J Hum Resour. 2000;35(4):716-33.
27.
Wagstaff A, Van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J Econometrics. 2003;112(1):207–23.CrossRef
28.
Wagstaff A. Reply to Guido Erreygers and Tom Van Ourti’s comment on ‘The concentration index of a binary outcome revisited’. Health Econ. 2011;20(10):1166–8.CrossRefPubMed
29.
Doorslaer EV, Koolman X, Jones AM. Explaining income‐related inequalities in doctor utilisation in Europe. Health Econ. 2004;13(7):629–47.CrossRefPubMed
30.
Fang P, Dong S, Xiao J, Liu C, Feng X, Wang Y. Regional inequality in health and its determinants: evidence from China. Health Policy. 2010;94(1):14–25.CrossRefPubMed
31.
Mohammadbeigi A, Hassanzadeh J, Eshrati B, Rezaianzadeh A. Socioeconomic inequity in health care utilization, Iran. J Epidemiol Glob Health. 2013;3(3):139–46.CrossRefPubMed
32.
Elwell-Sutton TM, Chao QJ, Wei SZ, Cheng KK, Tai HL, Leung GM, et al. Inequality and inequity in access to health care and treatment for chronic conditions in China: The Guangzhou Biobank Cohort Study. Health Policy Plan. 2013;28(5):467–79.CrossRefPubMed
33.
Deepak S, Ruchi V, Mavalankar DV, Sarah T. Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data. Global Health Action. 2015;6(1):99–111.
34.
Bhogal SK, Reddigan JI, Rotstein OD, Cohen A, Glockler D, Tricco AC, et al. Inequity to the Utilization of Bariatric Surgery: a Systematic Review and Meta-Analysis. Obes Surg. 2015;25:1–12.CrossRef
35.
Ridde V, Agier I, Jahn A, Mueller O, Tiendrebéogo J, Yé M, et al. The impact of user fee removal policies on household out-of-pocket spending: evidence against the inverse equity hypothesis from a population based study in Burkina Faso. EUR J HEALTH ECON. 2014;16(1):55-64.
36.
Sato M, Gilson L. Exploring health facilities’ experiences in implementing the free health-care policy (FHCP) in Nepal: how did organizational factors influence the implementation of the user-fee abolition policy? Health Policy Plan. 2015;30(10):1272–88.CrossRefPubMed
37.
Zhou M, Chen L. Analysis of the result of the implementation of the free policy for the basic public health service items for the child health care in Kangqiao Community. Shanghai Med Pharmaceutical J. 2015.
38.
Witter S, Garshong B, Ridde V. An exploratory study of the policy process and early implementation of the free NHIS coverage for pregnant women in Ghana. Int J Equity Health. 2013;12(5):898.
39.
Sheikh K, Ranson MK, Gilson L. Explorations on people centredness in health systems. Health Policy Plan. 2014;29(Suppl2):i1–5.CrossRef
40.
Andrew MK, Mcneil S, Merry H, Rockwood K. Rates of influenza vaccination in older adults and factors associated with vaccine use: A secondary analysis of the Canadian Study of Health and Aging. BMC Public Health. 2004;4(15):1–8.
41.
Yang Z, Peng Y, Wu S, Ma C, Seale H, Macintyre CR, et al. A cross-sectional study of factors associated with uptake of vaccination against influenza among older residents in the postpandemic season in Beijing, China. BMJ Open. 2013;3(11):e3662.CrossRef
42.
Lin Y, Huang L, Nie S, Liu Z, Yu H, Yan W, et al. Knowledge, Attitudes and Practices (KAP) related to the Pandemic (H1N1) 2009 among Chinese General Population: a Telephone Survey. BMC Infect Dis. 2011;11(20):1–9.
43.
Jiang XA, Yuan M. Community Communication and Rural Community Culture: A Case Study of Fitness Dance Activity in X-town in the Central Part of Jiangsu. Soc Sci Nanjing. 2013;1:54–62.
44.
Cao J, Jing W, Cao J, Jing W. Evolution of the perception of the doctor’s role in China. Lancet. 2014;384(9945):742.CrossRefPubMed
45.
Liang LZ, Zhao-Feng LV, Wang XY, Yang J, Song XX. Enlightenment of Beijing Village Doctor-patient Relationship in the Barefoot Doctors Period to the Contemporary Rural Doctor-patient Relationship. Chinese Medical Ethics. 2012;25(2):60–2.
46.
Desjarlais-Deklerk K, Wallace JE. Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics. BMC Health Serv Res. 2013;13(7):261.CrossRefPubMedPubMedCentral
47.
Mehra P. Influence of socio-demographic factors in doctor-patient communication in India. Int J Indian Culture Business Management. 2014;8:387–412.CrossRef
48.
49.
Meng Q. Developing and implementing equity-promoting health care policies in China. Health Systems Knowledge Network of the World Health Organization’s Commission on Social Determinants of Health. China. 2007.
50.
Yip W, Subramanian SV, Mitchell AD, Lee DT, Wang J, Kawachi I. Does social capital enhance health and well-being? Evidence from rural China. Soc Sci Med. 2007;64(1):35–49.CrossRefPubMed
51.
Alison B, Lucy Y, Angus N, Susan M. Factors associated with uptake of vaccination against pandemic influenza: a systematic review. Vaccine. 2011;29(38):6472–84.CrossRef
52.
James CD, Hanson K, Mcpake B, Balabanova D, Gwatkin D, Hopwood I, et al. To retain or remove user fees? Appl Health Econ Health Policy. 2006;5(3):137–53.CrossRefPubMed
53.
Xin L, Min L. Willingness of local residents to accept paid influenza vaccine in Chongqing and its influencing factors: a survey. Chinese J General Practitioners. 2013;12(7):558–9.
54.
Mackenbach JP. Education programs are likely to improve health, but will they improve health equity? Am J Prev Med. 2015;48(5):e5–6.CrossRefPubMed
55.
Ahmed S, Creanga AA, Gillespie DG, Tsui AO. Economic Status, Education and Empowerment: Implications for Maternal Health Service Utilization in Developing Countries. PLoS One. 2010;5(6):e11190.CrossRefPubMedPubMedCentral
56.
Travis CB, Meltzer AL, Howerton DM. Gender and HealthCare Utilization. Handbook of Gender Research in Psychology. Springer New York. 2010:517-40.
57.
Rezapoor A, Roumiani Y, Azar FEF, Ghazanfari S, Mirzaei S, Asiabar AS, et al. Effective factors on utilization and access to health care: a population-based study in Kerman. J Health Administration. 2015;18(60):24–35.
58.
Zhao L. CPC’s Practice and Exploration of Resolving the Problems Concerning People’s Livelihood in the Early Days of New China. J Liaoning Normal University. 2014;37(6):768–73.
59.
60.
Studer J, Baggio S, Mohler-Kuo M, Dermota P, Gaume J, Bertholet N, et al. Examining non-response bias in substance use research--are late respondents proxies for non-respondents? Drug Alcohol Dependence. 2013;132(1):316–23.CrossRefPubMed
Metadata
Title
Who benefits most from influenza vaccination policy: a study among the elderly in Beijing, China
Authors
Tongtong Li
Min Lv
Trudy Lei
Jiang Wu
Xinghuo Pang
Ying Deng
Zheng Xie
Publication date
01-12-2016
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2016
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-016-0332-x

Other articles of this Issue 1/2016

International Journal for Equity in Health 1/2016 Go to the issue

Research

Strengthening national capacities for researching on Social Determinants of Health (SDH) towards informing and addressing health inequities in Tanzania

Research

Catastrophic health expenditure and impoverishment in Mongolia

Erratum

Erratum to: Economic crisis and health inequalities: evidence from the European Union

Commentary

Looking beyond the veil of the European crisis - the need to uncover the structural causes of health inequalities

Research

Socioeconomic inequalities in activities of daily living limitations and in the provision of informal and formal care for noninstitutionalized older Brazilians: National Health Survey, 2013

Research

Assessment of the spatial accessibility to health professionals at French census block level