title: Pneumococcal vaccination of the elderly during visits to acute care providers: who are vaccinated?
abstract: OBJECTIVE
  Many elderly remain unvaccinated against invasive pneumococcal disease yet frequently visit acute care providers where they have an opportunity to receive the pneumococcal vaccine. We describe factors associated with pneumococcal vaccination in adults aged 65 years and older during visits to acute care providers.
  
  
  METHODS
  The study included all elderly aged 65 years of age and older enrolled in a health insurance registry in a large Canadian city in 2009. Pneumococcal vaccination status was determined using a vaccination administrative database. Unvaccinated elderly were linked to ambulatory and inpatient care databases to determine acute care visits. Logistic regression was used to determine odds ratios for vaccination during a first visit to an acute care provider in 2009.
  
  
  RESULTS
  Of 53,249 unvaccinated elderly, 23,574 presented to at least one acute care provider in 2009. Acute care visits were significantly associated with receipt of pneumococcal vaccine (11.0% vs. 7.8%, risk adjusted odds ratio [OR]=1.53; 95% confidence interval [CI]=1.44,1.62), particularly ambulatory care visits during influenza season (OR=4.36; 95% CI=2.86,6.66) and inpatient visits with lengths of stay >14 days (OR=7.71, 95% CI=4.41,13.47).
  
  
  CONCLUSIONS
  Acute care visits were associated with greater pneumococcal vaccine uptake for the elderly during the annual influenza season and long hospital stays.
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: david.sabapathy@shaw.ca.
authors.forename: David
authors.initials: D
authors.lastname: Sabapathy
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Strong
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Myers
authors.affiliation: Alberta Health Services, Calgary, Alberta, Canada.
authors.forename: Bing
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002170:Canada; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012307:Risk Factors
chemical_list: D022242:Pneumococcal Vaccines
keywords: Elderly; Health services; Immunization; Pneumococcal infections; Pneumococcal vaccines; Public health; Vaccination