Abstract
Objective To assess vaccination coverage and predictors of vaccination among a Canadian population of rheumatology patients in routine clinical care.
Methods In this cross-sectional study, consecutive adult patients presenting to a tertiary rheumatology clinic at the McGill University Health Center between May and September 2015 were asked to fill a survey on vaccination. Patients self-identified as having rheumatoid arthritis (RA), systemic autoimmune rheumatic diseases (SARD), spondyloarthropathies (SpA), or other diseases (OD). Multivariate logistical regression analyses were performed to evaluate patient and physician factors associated with vaccination (influenza, pneumococcal, hepatitis B virus [HBV]). Published Quebec general population influenza and pneumococcal vaccination rates in those aged ≥ 65 were used as comparative baseline rates.
Results 352 patients were included in the analysis (RA:136, SARD:113, SpA:47, OD:56). Vaccination rates were reported as: (1) influenza: RA:48.5%, SARD:42.0%, SpA:31.9%, OD:88.9%, Quebec general population:58.5%; (2) pneumococcal: RA:42.0%, SARD:37.8%, SpA:29.7%, OD:33.3%, Quebec general population:53.2%; (3) HBV: RA:33.6%, SARD:55.6%, SpA:73.5%, OD:36.8%; and (4) herpes zoster: RA:5.6%, SARD:28.6%, SpA:25.0%, OD:16.7%. Physician recommendation was the strongest independent predictor of vaccination across all vaccine types (influenza: OR 8.56, 95% CI 2.80-26.2, p<0.001; pneumococcal: OR 314, 95% CI 73.0-1353, p<0.001; HBV: OR 12.8, 95% CI 5.27-31.1, p<0.001). Disease group, disease duration, comorbidities, treatment type, and being followed by a primary care physician were not significantly associated with vaccination.
Conclusion There is suboptimal immunization coverage among ambulatory rheumatology patients. An important role for patient and physician education is highlighted from our study, especially as physician recommendation of vaccination was strongly predictive of vaccine uptake.
