Influenza and pneumococcal vaccination rates among smokers: Data from the 2006 Behavioral Risk Factor Surveillance System☆
Introduction
Both influenza and pneumonia have consistently been listed as leading causes of death among persons in the United States. The latest mortality data from the Centers for Disease Control and Prevention (CDC) state that influenza and pneumonia combined were ranked as the eighth leading cause of death in the U.S. in 2004 ((1)Heron, 2007), falling one spot from the seventh leading cause of death in 2003 ((2)Herron and Smith, 2007).
These diseases have a serious impact on the U.S. health care system. It is estimated that there are nearly one million cases of community-acquired pneumonia among seniors each year in the United States (Jackson et al., 2004). Of those cases that require hospitalization, each admission costs between $7000 and $8000 (De Graeve and Beutels, 2004). The Centers for Disease Control and Prevention estimates that each year in the United States, pneumococcal disease accounts for 500,000 cases of pneumonia (MMWR, 1997). For influenza, it is estimated that there are over a quarter of a million hospitalizations annually (Thompson et al., 2004) and that direct medical costs because of influenza infection average $10.4 billion (Molinari et al., 2007). Vaccinations against these diseases are recommended to help prevent infection and reduce complications, and are particularly recommended for at-risk groups such as those with chronic diseases (United States Preventive Health Services Task Force, 2006, Morbidity and Mortality Weekly Report, 1997, Morbidity and Mortality Weekly Report, 2007).
Persons who smoke cigarettes are especially vulnerable to developing influenza- and pneumonia-related complications, such as respiratory infections. Smoking creates structural changes in the respiratory tract and also decreases the immune response making respiratory infections more likely to occur (Arcavi and Benowitz, 2004). Smoking has been identified in population-based studies as a risk factor for the development of community-acquired pneumonia (Ortqvist et al., 2005, Almirall et al., 1999) and influenza (Razani-Boroujerdi et al., 2004), and is also associated with increased morbidity and mortality from secondary infections because of influenza and pneumonia (Murin and Biello, 2005). Furthermore, the CDC has reported that from 2001 through 2004, there have been on average, approximately 9000 smoking-attributable deaths per year from influenza and pneumonia among persons fifty years of age and older ((1)Centers for Disease Control and Prevention, Smoking Attributable Mortality., Centers for Disease Control and Prevention.).
Studies conducted in countries other than the United States have indicated that persons who smoke are less likely to receive influenza and pneumococcal immunizations, especially among the elderly (Lopez de Andres et al., 2007, Nicholson et al., 1999). Currently, The Guide to Preventive Clinical Services does not recommend that smokers receive these vaccines (USPTF, 2006). Given that persons who smoke have a susceptibility to respiratory infections related to influenza and pneumonia, it is important to better understand if smoking status could be a barrier to preventive health care, such as receipt of immunizations in the United States. Therefore, the purpose of this study was to assess if influenza and pneumococcal vaccination rates differ among never smokers, former smokers, and current smokers using a pooled, U.S. sample.
Section snippets
Methods
Data for this study were taken from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. The BRFSS is an ongoing, state-based, landline telephone survey that collects information on health risk behaviors, preventive health practices, and access to and use of health services related to chronic conditions among adults aged ≥ 18 years. In 2006, a total of 355,710 participants from all 50 U.S. states, plus Puerto Rico and the U.S. Virgin Islands, responded to this survey. Data are
Results
Of the 198,500 survey respondents, 48.5% were never smokers (n = 96,282), 36.6% were former smokers (n = 72,557), and 14.9% were current smokers (29,661). Differences in demographics were found among the three smoking groups. The average age of never smokers was 64.1 years; 65.4 years for former smokers, and 59.7 years for current smokers. Former smokers had the lowest proportion of females compared to both current and never smokers. Each smoking classification was predominantly white with former
Discussion
Using a large U.S. sample, two important aspects of the receipt of immunizations were apparent. First, a higher percentage of former smokers reported receiving both influenza and pneumococcal vaccinations than never or current smokers. Secondly, current smokers had lower odds of receiving the influenza vaccinations when compared to never smokers, but not lower odds of receiving the pneumococcal vaccination. However, the direction of the association between current smokers and pneumococcal
Conclusion
Our findings suggest that persons who smoke and do not receive vaccinations could be in a much more precarious situation because of the increased risk of developing respiratory infections, which are both costly to treat and are potentially fatal. Efforts toward health promotion should include following smoking cessation guidelines ((1) Fiore and Jaen, 2008; (2) Fiore et al., 2000) and increasing pneumococcal and influenza vaccination rates among smokers. Both efforts would potentially stand to
Conflict of interest
The authors declare that there is no conflict of interest.
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Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.