title: Effectiveness of influenza vaccination in patients with end-stage renal disease receiving hemodialysis: a population-based study.
abstract: BACKGROUND
  Little is known on the effectiveness of influenza vaccine in ESRD patients. This study compared the incidence of hospitalization, morbidity, and mortality in end-stage renal disease (ESRD) patients undergoing hemodialysis (HD) between cohorts with and without influenza vaccination.
  
  
  METHODS
  We used the insurance claims data from 1998 to 2009 in Taiwan to determine the incidence of these events within one year after influenza vaccination in the vaccine (N = 831) and the non-vaccine (N = 3187) cohorts. The vaccine cohort to the non-vaccine cohort incidence rate ratio and hazard ratio (HR) of morbidities and mortality were measured.
  
  
  RESULTS
  The age-specific analysis showed that the elderly in the vaccine cohort had lower hospitalization rate (100.8 vs. 133.9 per 100 person-years), contributing to an overall HR of 0.81 (95% confidence interval (CI) 0.72-0.90). The vaccine cohort also had an adjusted HR of 0.85 [95% CI 0.75-0.96] for heart disease. The corresponding incidence of pneumonia and influenza was 22.4 versus 17.2 per 100 person-years, but with an adjusted HR of 0.80 (95% CI 0.64-1.02). The vaccine cohort had lowered risks than the non-vaccine cohort for intensive care unit (ICU) admission (adjusted HR 0.20, 95% CI 0.12-0.33) and mortality (adjusted HR 0.50, 95% CI 0.41-0.60). The time-dependent Cox model revealed an overall adjusted HR for mortality of 0.30 (95% CI 0.26-0.35) after counting vaccination for multi-years.
  
  
  CONCLUSIONS
  ESRD patients with HD receiving the influenza vaccination could have reduced risks of pneumonia/influenza and other morbidities, ICU stay, hospitalization and death, particularly for the elderly.
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University College of Medicine, Taichung, Taiwan.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.forename: Po-Chang
authors.initials: PC
authors.lastname: Lin
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.forename: Yao-Lung
authors.initials: YL
authors.lastname: Liu
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.forename: Donald E
authors.initials: DE
authors.lastname: Morisky
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007252:Influenza Vaccines / Q000276:immunology*; D007251:Influenza, Human / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011159:Population Surveillance; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012306:Risk; D013624:Taiwan / Q000453:epidemiology; D014611:Vaccination; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines