title: Effectiveness of the influenza vaccine in preventing admission to hospital and death in people with type 2 diabetes.
abstract: BACKGROUND
  The health burden caused by seasonal influenza is substantial. We sought to examine the effectiveness of influenza vaccination against admission to hospital for acute cardiovascular and respiratory conditions and all-cause death in people with type 2 diabetes.
  
  
  METHODS
  We conducted a retrospective cohort study using primary and secondary care data from the Clinical Practice Research Datalink in England, over a 7-year period between 2003/04 and 2009/10. We enrolled 124 503 adults with type 2 diabetes. Outcome measures included admission to hospital for acute myocardial infarction (MI), stroke, heart failure or pneumonia/influenza, and death. We fitted Poisson regression models for influenza and off-season periods to estimate incidence rate ratios (IRR) for cohorts who had and had not received the vaccine. We used estimates for the summer, when influenza activity is low, to adjust for residual confounding.
  
  
  RESULTS
  Study participants contributed to 623 591 person-years of observation during the 7-year study period. Vaccine recipients were older and had more comorbid conditions compared with nonrecipients. After we adjusted for covariates and residual confounding, vaccination was associated with significantly lower admission rates for stroke (IRR 0.70, 95% confidence interval [CI] 0.53-0.91), heart failure (IRR 0.78, 95% CI 0.65-0.92) and pneumonia or influenza (IRR 0.85, 95% CI 0.74-0.99), as well as all-cause death (IRR 0.76, 95% CI 0.65-0.83), and a nonsignificant change for acute MI (IRR 0.81, 95% CI 0.62-1.04) during the influenza seasons.
  
  
  CONCLUSIONS
  In this cohort of patients with type 2 diabetes, influenza vaccination was associated with reductions in rates of admission to hospital for specific cardiovascular events. Efforts should be focused on improvements in vaccine uptake in this important target group as part of comprehensive secondary prevention.
authors.affiliation: Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust e.vamos@imperial.ac.uk.
authors.forename: Eszter P
authors.initials: EP
authors.lastname: Vamos
authors.affiliation: Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.
authors.forename: Utz J
authors.initials: UJ
authors.lastname: Pape
authors.affiliation: Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.
authors.forename: Vasa
authors.initials: V
authors.lastname: Curcin
authors.affiliation: Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Harris
authors.affiliation: Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Valabhji
authors.affiliation: Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.affiliation: Department of Primary Care & Public Health (Vamos, Pape, Curcin, Harris, Majeed, Millett), Imperial College London, London, UK; Department of Diabetes and Endocrinology (Valabhji), St Mary's Hospital, Imperial College Healthcare NHS Trust.
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000517:prevention & control; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000517:prevention & control; D011014:Pneumonia / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000401:mortality / Q000517:prevention & control
chemical_list: D007252:Influenza Vaccines