title: The free vaccination policy of influenza in Beijing, China: The vaccine coverage and its associated factors.
abstract: BACKGROUND
  In order to improve influenza vaccination coverage, the coverage rate and reasons for non-vaccination need to be determined. In 2007, the Beijing Government published a policy providing free influenza vaccinations to elderly people living in Beijing who are older than 60. This study examines the vaccination coverage after the policy was carried out and factors influencing vaccination among the elderly in Beijing.
  
  
  METHODS
  A cross-sectional survey was conducted through the use of questionnaires in 2013. A total of 1673 eligible participants were selected by multistage stratified random sampling in Beijing using anonymous questionnaires in-person. They were surveyed to determine vaccination status and social demographic information.
  
  
  RESULTS
  The influenza vaccination coverage was 38.7% among elderly people in Beijing in 2012. The most common reason for not being vaccinated was people thinking they did not need to have a flu shot. After controlling for age, gender, income, self-reported health status, and the acceptance of health promotion, the rate in rural areas was 2.566 (95% confidence interval [CI], 1.801-3.655, P<0.010) times greater than that in urban areas. Different mechanisms of health education and health promotion have different influences on vaccination uptake. Those whom received information through television, community boards, or doctors were more likely to get vaccinated compared to those who did not (Odds Ratio [OR]=1.403, P<0.010; OR=1.812, P<0.010; OR=2.647, P<0.010).
  
  
  CONCLUSIONS
  The influenza vaccine coverage in Beijing is much lower than that of developed countries with similar policies. The rural-urban disparity in coverage rate (64.1% versus 33.5%), may be explained by differing health provision systems and personal attitudes toward free services due to socioeconomic factors. Methods for increasing vaccination levels include increasing the focus on primary care and health education programs, particularly recommendations from doctors, to the distinct target populations, especially with a focus on expanding these efforts in urban areas.
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing 100013, PR China.
authors.forename: Min
authors.initials: M
authors.lastname: Lv
authors.affiliation: School of Public Health, Peking University, Beijing 100191, PR China.
authors.forename: Renfei
authors.initials: R
authors.lastname: Fang
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing 100013, PR China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Wu
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing 100013, PR China.
authors.forename: Xinghuo
authors.initials: X
authors.lastname: Pang
authors.affiliation: Beijing Center for Disease Prevention and Control, Beijing 100013, PR China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Deng
authors.affiliation: School of Public Health of Columbia University, NY 10032, USA.
authors.forename: Trudy
authors.initials: T
authors.lastname: Lei
authors.affiliation: School of Public Health, Peking University, Beijing 100191, PR China. Electronic address: xiezheng@bjmu.edu.cn.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Xie
mesh_terms: D000368:Aged; D000068476:Beijing; D003430:Cross-Sectional Studies; D005260:Female; D006291:Health Policy; D006293:Health Promotion; D054625:Healthcare Disparities; D006801:Humans; D017589:Immunization Programs; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D014505:Urban Population; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines
keywords: China; Elderly people; Influenza vaccine coverage; Rural–urban disparity