Socioeconomic determinants of vaccination against pneumococcus in 763 945 patients with heart failure

Respiratory infections are the leading cause of acute decompensation, hospitalization and higher mortality in heart failure (HF) patients. Despite recommendations, vaccination coverage against pneumococcus and influenza remains alarmingly low (3% and 50% in 2018, respectively). This study aimed to identify factors associated with vaccination among HF patients using data from the Nationwide Health Claims Database for 2020, in France. The patients were followed during the entire year 2020. At least one dose of PCV13 was considered as a proxy for vaccination. The model used was a multivarable logistic regression.

Among 763 945 HF patients (mean age 76.7 years, 54.2% male), the mean annual visits were 7.0 with a general practitioner, 1.68 with a specialist and 70.0 with a nurse. Despite frequent healthcare contacts, vaccination coverage was only 12.6% for pneumococcus (PCV13) and 63.1% for influenza.

In multivariable analyses, at least one dose of the PCV13 was less often received when patients were (1) older (odd ratio (OR): 0.71 [0.67; 0.74], P < 0.0001 and 0.48 [0.46; 0.51], P < 0.0001) in patients 76–85 and older than 85 years old, respectively, (2) women (OR: 0.916 [0.903; 0.929], P < 0.0001) or 3/when they presented social deprivation (for the quintile Q5 of deprivation index, OR was 0.893 [0.872; 0.914], P < 0.0001). Pneumoccocus vaccination was associated with influenza vaccination or with better access to health services.

We need to consider factors, such as age, sex and social deprivation, to adapt public health initiatives supporting a significantly and sustainably increase pneumococcal vaccination coverage in frail HF patients.