Influenza vaccination and the endurance against air pollution among elderly with acute coronary syndrome.
Air pollution, weather condition and influenza are known risk factors of acute coronary syndrome (ACS) among elderly people. The influenza vaccine (IV) has been shown to reduce major cardiovascular events. The purpose of this study was to compare resistance to air pollution and weather factors causing ACS between vaccinated and less-vaccinated elderly people.



A case-crossover design was applied to 1835 elderly ACS patients who were obtained from the 1-million sample of Taiwan National Health Insurance Research Data with inclusion criteria: (1) the first diagnosis of ACS was in cold season and at age 68 or more, (2) had received the free IV program at least once during the period 3years before the ACS. They were stratified into two groups: 707 had received flu vaccinations for all the 3years and the remaining 1128 had not. The measurements of air pollutants, temperature, and humidity corresponding to each of the 3days prior to the ACS diagnosis date were retrieved from the data banks of the Taiwan Environmental Protection Administration and Central Weather Bureau.



Increases in air pollution concentrations of CO, NO2, PM10or PM2.5and decreases in temperature significantly influenced the risk of ACS for the non-continuously vaccinated elderly population; however, less significant effects were observed for the continuously vaccinated population.



Consecutive influenza vaccination may potentially offer resistance against the detrimental effects of air pollution and changes in temperature in frail elderly adults with ACS. Future studies are needed to directly assess the interaction effect between the vaccination and environmental factors on ACS.
Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Institute of Statistics and Information Science, National Changhua University of Education, Taiwan. Electronic address: chinghui@cch.org.tw.
Ching-Hui
CH
Huang
Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung, Taiwan. Electronic address: dychao@nchu.edu.tw.
Day-Yu
DY
Chao
Public Health Bureau, Yunlin County, Taiwan. Electronic address: iblian@ibms.sinica.edu.tw.
Chao-Chun
CC
Wu
Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung, Taiwan; Public Health Bureau, Yunlin County, Taiwan. Electronic address: yls007@ylshb.gov.tw.
Shu-Yun
SY
Hsu
Department of Gastroenterology, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: 28071@cch.org.tw.
Maw-Soan
MS
Soon
Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung-Shan Medical University, Taichung, Taiwan. Electronic address: chiachu@cch.org.tw.
Chia-Chu
CC
Chang
Internal Medicine Research Center, Changhua Christian Hospital, Changhua, Taiwan. Electronic address: 179297@cch.org.tw.
Chew-Teng
CT
Kor
Institute of Statistics and Information Science, National Changhua University of Education, Taiwan. Electronic address: j102858@cc.ncue.edu.tw.
Wan-Tzu
WT
Chang
Institute of Statistics and Information Science, National Changhua University of Education, Taiwan. Electronic address: maiblian@cc.ncue.edu.tw.
Ie-Bin
IB
Lian
D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D000397:Air Pollution / Q000009:adverse effects*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D006813:Humidity; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D007251:Influenza, Human / Q000150:complications* / Q000517:prevention & control*; D008297:Male; D013624:Taiwan / Q000453:epidemiology; D013696:Temperature
D007252:Influenza Vaccines
Acute coronary syndrome; Air pollution; Case–crossover; Influenza vaccine; Meteorology