Differences in Influenza Vaccination Coverage between Adult Immigrants and Italian Citizens at Risk for Influenza-Related Complications: A Cross-Sectional Study.
BACKGROUND
Due to their increased vulnerability, immigrants are considered a priority group for communicable disease prevention and control in Europe. This study aims to compare influenza vaccination coverage (IVC) between regular immigrants and Italian citizens at risk for its complications and evaluate factors affecting differences.


METHODS
Based on data collected by the National Institute of Statistics during a population-based cross-sectional survey conducted in Italy in 2012-2013, we analysed information on 42,048 adult residents (≥ 18 years) at risk for influenza-related complications and with free access to vaccination (elderly residents ≥ 65 years and residents with specific chronic diseases). We compared IVC between 885 regular immigrants and 41,163 Italian citizens using log-binomial models and stratifying immigrants by area of origin and length of stay in Italy (recent: < 10 years; long-term: ≥ 10 years).


RESULTS
IVC among all immigrants was 16.9% compared to 40.2% among Italian citizens (vaccination coverage ratio (VCR) = 0.42, 95% confidence interval (CI): 0.36-0.49). Adjusting for sex, age and area of residence, this difference was greatly reduced but remained statistically significant (VCR = 0.71, 95 CI: 0.61-0.81). Further adjustment for socio-economic factors (education, occupation, family composition and economic status) and a composite indicator of health-services utilization did not affect the difference (VCR = 0.78, 95% CI: 0.68-0.90). However, after adjustments, only long-term immigrants from Africa (VCR = 0.49, 95% CI: 0.28-0.85) and recent immigrants (VCR = 0.58, 95% CI: 0.43-0.78) showed a significantly different IVC compared to Italian citizens.


CONCLUSIONS
Differences in demographic characteristics, socio-economic conditions and health-services utilization explained the reduced IVC in most long-term immigrants compared to Italian citizens. By contrast, these differences did not explain the reduced IVC in long-term immigrants from Africa and recent immigrants. This suggests that IVC in these sub-groups is affected by other informal barriers (e.g., cultural and linguistic) that need to be investigated to promote effective immunization access strategies.
National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Italian National Institute of Health (ISS), Rome, Italy.
Massimo
M
Fabiani
National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Italian National Institute of Health (ISS), Rome, Italy.|European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
Flavia
F
Riccardo
National Institute for Health, Migration and Poverty (INMP), Rome, Italy.
Anteo
A
Di Napoli
National Institute of Statistics (ISTAT), Rome, Italy.
Lidia
L
Gargiulo
National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Italian National Institute of Health (ISS), Rome, Italy.
Silvia
S
Declich
National Institute for Health, Migration and Poverty (INMP), Rome, Italy.
Alessio
A
Petrelli
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D007558:Italy; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D014611:Vaccination; D055815:Young Adult
D007252:Influenza Vaccines