Michael L. Anderson, PhD; Carlos Dobkin, PhD; Devon Gorry, PhD
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the U.S. Department of Agriculture.
Acknowledgment: The authors thank seminar participants at ASHEcon; Brigham Young University; Clemson University; University of California, Irvine; University of Connecticut; University of Illinois at Urbana-Champaign; and University of South Carolina.
Grant Support: By award R01AG044796 from the National Institute on Aging of the National Institutes of Health and by Hatch project 233535 from the National Institute of Food and Agriculture of the U.S. Department of Agriculture. Eighty percent of the project was funded by federal sources, and none was funded by nongovernmental sources.
Disclosures: Drs. Anderson, Dobkin, and Gorry report grants from the National Institute on Aging of the National Institutes of Health during the conduct of the study. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3075.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available at https://doi.org/10.6078/D1Q11H. Data set: Available for purchase from the Royal College of General Practitioners Research and Surveillance Centre, the U.K. Office for National Statistics, the U.K. National Health Service Hospital Episode Statistics, the U.K. Data Archive, and Picker Institute Europe. The code archive provides details.
Corresponding Author: Michael L. Anderson, PhD, 714 University Hall, MC3310, University of California, Berkeley, Berkeley, CA 94720; e-mail, email@example.com.
Current Author Addresses: Dr. Anderson: 714 University Hall, MC3310, University of California, Berkeley, Berkeley, CA 94720.
Dr. Dobkin: 441 Engineering 2, University of California, Santa Cruz, 1156 High Street, Santa Cruz, CA 95064.
Dr. Gorry: John E. Walker Department of Economics, 228 Sirrine Hall, Clemson, SC 29634.
Author Contributions: Conception and design: M.L. Anderson, C. Dobkin, D. Gorry.
Analysis and interpretation of the data: M.L. Anderson, C. Dobkin, D. Gorry.
Drafting of the article: M.L. Anderson, C. Dobkin, D. Gorry.
Critical revision of the article for important intellectual content: M.L. Anderson, C. Dobkin, D. Gorry.
Final approval of the article: M.L. Anderson, C. Dobkin, D. Gorry.
Provision of study materials or patients: C. Dobkin.
Statistical expertise: M.L. Anderson, C. Dobkin, D. Gorry.
Obtaining of funding: M.L. Anderson, C. Dobkin, D. Gorry.
Administrative, technical, or logistic support: C. Dobkin.
Collection and assembly of data: C. Dobkin, D. Gorry.
Observational studies using traditional research designs suggest that influenza vaccination reduces hospitalizations and mortality among elderly persons. Accordingly, health authorities in some countries prioritize vaccination of this population. Nevertheless, questions remain about this policy's effectiveness given the potential for bias and confounding in observational data.
To determine the effectiveness of the influenza vaccine in reducing hospitalizations and mortality among elderly persons by using an observational research design that reduces the possibility of bias and confounding.
A regression discontinuity design was applied to the sharp change in vaccination rate at age 65 years that resulted from an age-based vaccination policy in the United Kingdom. In this design, comparisons were limited to individuals who were near the age-65 threshold and were thus plausibly similar along most dimensions except vaccination rate.
England and Wales.
Adults aged 55 to 75 years residing in the study area during 2000 to 2014.
Seasonal influenza vaccine.
Hospitalization and mortality rates by month of age.
The data included 170 million episodes of care and 7.6 million deaths. Turning 65 was associated with a statistically and clinically significant increase in rate of seasonal influenza vaccination. However, no evidence indicated that vaccination reduced hospitalizations or mortality among elderly persons. The estimates were precise enough to rule out results from many previous studies.
The study relied on observational data, and its focus was limited to individuals near age 65 years.
Current vaccination strategies prioritizing elderly persons may be less effective than believed at reducing serious morbidity and mortality in this population, which suggests that supplementary strategies may be necessary.
National Institute on Aging.
Anderson ML, Dobkin C, Gorry D. The Effect of Influenza Vaccination for the Elderly on Hospitalization and Mortality: An Observational Study With a Regression Discontinuity Design. Ann Intern Med. 2020;:. [Epub ahead of print 3 March 2020]. doi: https://doi.org/10.7326/M19-3075
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Published: Ann Intern Med. 2020.
High Value Care, Hospital Medicine, Infectious Disease, Influenza, Prevention/Screening.
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