背景: 在老人族群,許多觀察性研究發現流行感冒疫苗可以減少後續全死因死亡的危險,但這些研究卻存在方法學上的爭議。此外,流行感冒疫苗是否可以降低老人族群發生急性心血管疾病的危險,則還沒有定論。 研究方法: 本研究採用回溯性世代研究,分析在2007年到2008年間,醫院的老年門診病人接受流感疫苗對全死因死亡以及心血管急症的影響。資料收集方式包括病患的病歷資料以及電話訪問。研究的預後為全死因死亡以及心血管急症.心血管急症的範圍包括急性心肌梗塞,心因性死亡,心因性急診求診,心因性住院,冠狀動脈再通術,以及急性腦血管疾病。研究追蹤的時間為流感盛行季節以及全季節 (定義為流感季節以及之後到十月一日前的時間)。 分析的方法分為兩部分,首先使用Cox proportional hazards model,對於共變因子作迴歸分析;之後採取propensity score matching的方法,選出匹配的個案作比較。 結果: 在2007-2008年,本研究收入接受流感疫苗者有445人,未接受疫苗者有318人。追蹤時間中位數為12個月(Q1: 11個月,Q3: 12個月),平均追蹤時間為11.3個月,其中發生31例死亡以及75例心血管急症。在全死因死亡部分,流感疫苗顯著的減少死亡的危險(在流感季節,hazard ratio 0.16,95% CI 0.045-0.57;在全季節,hazard ratio 0.15,95% CI 0.054-0.42)。而在心血管急症部分,流感疫苗並沒有減少危險(在流感季節 hazard ratio 0.65, 95% CI 0.33-1.28,在全季節: hazard ratio 0.81, 95% CI 0.50-1.31).經過propensity score match之後,接受疫苗與未接受疫苗各選出了251個匹配的個案。在全死因部分,匹配後的分析仍然顯示流感疫苗可以顯著的減少死亡危險 (在流感季節: hazard ratio 0.08,95% CI 0.01-0.59;在全季節: hazard ratio 0.1,95% CI 0.02-0.43) 。而在心血管急症,流感疫苗並沒有顯著的減少發生危險 (在流感季節: hazard ratio 0.58,95% CI 0.23-1.48; 在全季節: hazard ratio 0.64,95% CI 0.33-1.24)。 結論: 在老人族群,流感疫苗可以減少後續死亡的危險;在心血管急症,則沒有發現有顯著的保護效果。
Background: Influenza vaccination was reported to prevent all-cause death and hospitalization in the elderly. However, it is not clear whether influenza vaccination prevent acute cardiovascular events in this group. Method: We conducted a retrospective, hospital based cohort study during the 2007-2008 to assess the influence of influenza vaccine on the risk of all cause death and cardiovascular events. The follow-up periods were influenza season and whole season. The information was collected by telephone survey and medical record. Cox proportional hazards model and propensity score matching were used for analysis. Result: A total of 445 vaccinated patient and 318 non-vaccinated patients were included in our study. Median follow-up time was 12 (interquartile range: 11-12) month. During the follow-up period, 31 cases of all-cause death and 75 cases of acute cardiovascular event were noted. Vaccination was associated with lower risk of all-cause death (in influenza season: hazard ratio 0.16, 95% confidence interval 0.045-0.57; in whole season: hazard ratio 0.15, 95% confidence interval 0.054-0.42). In cardiovascular event, vaccination was associated with non-significant risk reduction (in influenza season: hazard ratio 0.65, 95% confidence interval 0.33-1.28; in whole season: hazard ratio 0.81, 95% confidence interval 0.50-1.31). By propensity score 1:1 matching, 251 matched pairs in the vaccinated and non-vaccinated group were investigated. In all- cause death, vaccination was associated with significant risk reduction (in influenza season: hazard ratio 0.08; 95% confidence interval 0.01-0.59; in whole season: hazard ratio 0.1; 95% confidence interval 0.02-0.43). In cardiovascular events, vaccination was associated with non-significant risk reduction (in influenza season: hazard ratio 0.58, 95% confidence interval 0.23-1.48; in whole season: hazard ratio 0.64, 95% confidence interval 0.33-1.24). In the subgroup analysis, influenza vaccine showed a borderline protective effect on acute cardiovascular event in subjects with younger age (hazard ratio 0.31, 95% confidence interval 0.09-1.14) and preexisting cardiovascular disease (hazard ratio 0.57, 95% confidence interval 0.26-1.24) in the influenza season. Conclusion: In the elderly, influenza vaccination reduced the risk of all- cause death both in influenza season and whole season. However, the vaccination did not have significant protective effect on cardiovascular event among elder ethnic Chinese.
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