title: Influenza vaccine delivery and effectiveness in end-stage renal disease.
abstract: BACKGROUND
  Influenza vaccination rates in the general population have been associated with improved outcomes, yet high-risk populations, such as end-stage renal disease (ESRD) patients, have received little attention in determining the potential benefits. This report assessed the frequency and effectiveness of influenza vaccination, while also assessing disparities in vaccination rates in the ESRD population.
  
  
  METHODS
  Using the United States Renal Data System research files containing claims for all Medicare ESRD patients, vaccination rates and outcomes among vaccinated and unvaccinated persons for the 1997 to 1998 and 1998 to 1999 influenza seasons were compared after adjustment for baseline demographic factors and health characteristics.
  
  
  RESULTS
  Vaccination rates in the ESRD population were less than 50% for each season. Influenza vaccination rates were lower in non-whites, women, younger patients, and peritoneal dialysis patients. Influenza vaccination was associated with a lower risk for hospitalization and death.
  
  
  CONCLUSIONS
  Despite universal coverage of free influenza vaccination, the ESRD population had a less than 50% vaccination rate for the years 1997 to 1998 and 1998 to 1999 as demonstrated by Medicare billing data. Substantial differences were found in vaccination rates among non-whites and peritoneal dialysis patients. This study confirms that the ESRD populations benefit from influenza vaccination, suggesting that dialysis providers should take advantage of all opportunities to immunize this high-risk group.
authors.affiliation: United States Renal Data System Coordinating Center and Minneapolis Medical Research Foundation, Minneapolis, Minnesota 55404, USA. dgilbertson@nephrology.org
authors.forename: David T
authors.initials: DT
authors.lastname: Gilbertson
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
authors.forename: A Marshall
authors.initials: AM
authors.lastname: McBean
authors.forename: Annamaria T
authors.initials: AT
authors.lastname: Kausz
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Collins
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010530:Peritoneal Dialysis; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D007252:Influenza Vaccines