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Protective effect of influenza vaccination on outcomes in geriatric stroke patients: A nationwide matched cohort study

  • Fai Lam
    Affiliations
    School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan

    Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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  • Ta-Liang Chen
    Affiliations
    Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan

    Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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  • Chun-Chuan Shih
    Affiliations
    The School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan
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  • Chao-Shun Lin
    Affiliations
    Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan

    Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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  • Chun-Chieh Yeh
    Affiliations
    Department of Surgery, China Medical University Hospital, Taichung, Taiwan

    Department of Surgery, University of Illinois, Chicago, IL, USA
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  • Yuarn-Jang Lee
    Affiliations
    Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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  • Chaur-Jong Hu
    Affiliations
    Department of Neurology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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  • Author Footnotes
    1 This author has equal contribution with the corresponding author.
    Hung-Yi Chiou
    Footnotes
    1 This author has equal contribution with the corresponding author.
    Affiliations
    School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
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  • Author Footnotes
    1 This author has equal contribution with the corresponding author.
    Chien-Chang Liao
    Correspondence
    Corresponding author. Department of Anesthesiology Taipei Medical University Hospital, 252 Wu-Xing Street, Taipei, 110, Taiwan.
    Footnotes
    1 This author has equal contribution with the corresponding author.
    Affiliations
    Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan

    Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan

    Department of Anesthesiology, Shuan Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
    Search for articles by this author
  • Author Footnotes
    1 This author has equal contribution with the corresponding author.

      Highlights

      • Stroke patients with influenza vaccination (IV) showed better outcome than non-vaccinated patients.
      • IV was associated with reduced post-stroke outcomes in various subgroups.
      • Less consumption of medical resources were also noted in stroke patients with IV.

      Abstract

      Background and aims

      The effects of influenza vaccination (IV) on stroke outcomes are unclear. The purpose of this study is to evaluate the outcomes after stroke in elderly individuals who have received an IV.

      Methods

      We used Taiwan's National Health Insurance Research Database 2000–2009 claims data to conduct a nested stroke cohort study including 148,909 hospitalized stroke patients aged 66 years and older. Using a matching procedure by propensity score, we selected 25,248 stroke patients with IV and 25,248 stroke patients without IV for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs of post-stroke complications and in-hospital mortality associated with IV.

      Results

      Stroke patients with IV had significantly lower risks of post-stroke pneumonia (OR = 0.79; 95% CI, 0.74–0.83), septicemia (OR = 0.78; 95% CI, 0.70–0.86), urinary tract infection (OR = 0.87; 95% CI, 0.83–0.92), and 30-day in-hospital mortality (OR = 0.60; 95% CI, 0.54–0.67) compared with non-IV stroke patients. Vaccinated stroke patients also had shorter hospital stays (p < 0.0001) and less medical expenditures (p < 0.0001) during stroke admission than the control group. Lower rates of post-stroke adverse events in patients with IV were noted in both sexes of all age groups with various types of stroke.

      Conclusions

      Stroke patients with IV showed fewer complications and lower mortality compared with non-IV patients. These findings suggest the urgent need to promote IV for this susceptible population of stroke patients.

      Graphical abstract

      Keywords

      Abbreviations:

      CI (confidence interval), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), IV (influenza vaccination), OR (odds ratio)
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