title: Influenza immunization in Canada's low-income population.
abstract: BACKGROUND
  Immunization offers the best protection from influenza infection. Little evidence describes disparities in immunization uptake among low-income individuals. Higher rates of chronic disease put this population at increased risk of influenza-related complications. This analysis examines if the type of main source of household income in low-income groups affects influenza immunization uptake. We hypothesized that individuals on social assistance have less access to immunization compared to those with employment earnings or seniors' benefits.
  
  
  METHODS
  Data was obtained from the Canadian Community Health Survey annual component 2009-2010. A total of 10,373 low-income respondents (<20,000$ Canadian per annum) were included. Logistic regression, stratified according to type of provincial publicly funded immunization program, was used to examine the association between influenza immunization (in the last 12 months) and main source of household income (employment earnings; social assistance as a combination of employment insurance or worker's compensation or welfare; or seniors' benefits).
  
  
  RESULTS
  Overall, 32.5% of respondents reported receiving influenza immunization. In multivariable analysis of universal publicly funded influenza immunization programs, those reporting social assistance (AOR 1.24, 95% CI 1.02-1.51) or seniors' benefits (AOR 1.56, 95% CI 1.23-1.98) were more likely to be immunized compared to those reporting employment earnings. Similar results were observed for high-risk programs.
  
  
  CONCLUSIONS
  Among the low-income sample, overall influenza immunization coverage is low. Those receiving social assistance or seniors' benefits may have been targeted due to higher rates of chronic disease. Programs reaching the workforce may be important to attain broader coverage. However, CCHS data was collected during the H1N1 pandemic influenza, thus results may not be generalizable to influenza immunization in non-pandemic years.
authors.affiliation: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. Leigh.Hobbs@oahpp.ca.
authors.forename: Jennifer Leigh
authors.initials: JL
authors.lastname: Hobbs
authors.forename: Jane A
authors.initials: JA
authors.lastname: Buxton
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002170:Canada; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000379:methods / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines