title: Influenza vaccination, inverse care and homelessness: cross-sectional survey of eligibility and uptake during the 2011/12 season in London.
abstract: BACKGROUND
  Influenza vaccination eligibility and uptake among homeless adults has not been previously assessed in the UK. This cross-sectional survey aimed to measure the proportion of homeless people visited by an NHS outreach service (Find and Treat) who were eligible for and had received vaccination during 2011/12.
  
  
  METHODS
  A cross-sectional survey was carried out in 27 separate homeless hostels, day centres and drug services in London between July and August in 2012. Eligibility for the survey was by virtue of being in attendance at one of 27 venues visited by Find and Treat. No specific exclusion criteria were used.
  
  
  RESULTS
  455 clients took part in the survey out of 592 approached (76.9%). A total of 190 homeless people (41.8%; 95% CI: 34.5,50.5) were eligible for influenza vaccination. In those aged 16-64, eligibility due to clinical risk factors was 38.9% (95% CI: 31.5,48.2). Uptake of vaccination in homeless 16-64 year olds with a clinical risk factor during the 2011/12 influenza season was 23.7% (95% CI: 19.8,28.3) compared to national levels of 53.2% (excluding pregnant women). In those aged over 65, uptake was 42.9% (95% CI: 16.7,100.0) compared with 74.0% nationally.
  
  
  CONCLUSIONS
  This study demonstrates that the homeless population have high levels of chronic health problems predisposing them to severe complications of influenza, but vaccine uptake levels that are less than half those seen among eligible GP patient groups in England. It provides a clear example of the health inequalities and inverse care law that impact this population. The results of this study provide strong justification for intensifying efforts to ensure homeless people have access to influenza vaccination.
authors.affiliation: Find & Treat, University College Hospitals NHS Foundation Trust, 2nd Floor - Hospital of Tropical Diseases, Mortimer Market Centre, 5th Floor East, 250 Euston Rd, London NW1 2PG, UK. alistairstory@gmail.com.
authors.forename: Alistair
authors.initials: A
authors.lastname: Story
authors.forename: Robert W
authors.initials: RW
authors.lastname: Aldridge
authors.forename: Tat
authors.initials: T
authors.lastname: Gray
authors.forename: Stan
authors.initials: S
authors.lastname: Burridge
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hayward
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004608:Eligibility Determination; D005260:Female; D054625:Healthcare Disparities; D006703:Ill-Housed Persons; D006801:Humans; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000517:prevention & control*; D008131:London; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D037841:Pregnant People; D012307:Risk Factors; D012621:Seasons; D012940:Social Problems; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines