Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population

Lone Simonsen, Thomas A. Reichert, Cecile Viboud, William C. Blackwelder, Robert J. Taylor, Mark Miller

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background Observational studies report that influenza vaccination reduces winter mortality risk from any cause by 50% among the elderly. Influenza vaccination coverage among elderly persons (≥65 years) in the United States increased from between 15% and 20% before 1980 to 65% in 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period. We tried to reconcile these conflicting findings by adjusting excess mortality estimates for aging and increased circulation of influenza A(H3N2) viruses.

Methods We used a cyclical regression model to generate seasonal estimates of national influenza-related mortality (excess mortality) among the elderly in both pneumonia and influenza and all-cause deaths for the 33 seasons from 1968 to 2001. We stratified the data by 5-year age group and separated seasons dominated by A(H3N2) viruses from other seasons.

Results For people aged 65 to 74 years, excess mortality rates in A(H3N2)-dominated seasons fell between 1968 and the early 1980s but remained approximately constant thereafter. For persons 85 years or older, the mortality rate remained flat throughout. Excess mortality in A(H1N1) and B seasons did not change. All-cause excess mortality for persons 65 years or older never exceeded 10% of all winter deaths.

Conclusions We attribute the decline in influenza-related mortality among people aged 65 to 74 years in the decade after the 1968 pandemic to the acquisition of immunity to the emerging A(H3N2) virus. We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10% of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.
OriginalsprogEngelsk
TidsskriftArchives of Internal Medicine
Vol/bind165
Udgave nummer3
Antal sider8
DOI
StatusUdgivet - 2005
Udgivet eksterntJa

Citer dette

Simonsen, Lone ; Reichert, Thomas A. ; Viboud, Cecile ; Blackwelder, William C. ; Taylor, Robert J. ; Miller, Mark. / Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population. I: Archives of Internal Medicine. 2005 ; Bind 165, Nr. 3.
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title = "Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population",
abstract = "Background Observational studies report that influenza vaccination reduces winter mortality risk from any cause by 50{\%} among the elderly. Influenza vaccination coverage among elderly persons (≥65 years) in the United States increased from between 15{\%} and 20{\%} before 1980 to 65{\%} in 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period. We tried to reconcile these conflicting findings by adjusting excess mortality estimates for aging and increased circulation of influenza A(H3N2) viruses.Methods We used a cyclical regression model to generate seasonal estimates of national influenza-related mortality (excess mortality) among the elderly in both pneumonia and influenza and all-cause deaths for the 33 seasons from 1968 to 2001. We stratified the data by 5-year age group and separated seasons dominated by A(H3N2) viruses from other seasons.Results For people aged 65 to 74 years, excess mortality rates in A(H3N2)-dominated seasons fell between 1968 and the early 1980s but remained approximately constant thereafter. For persons 85 years or older, the mortality rate remained flat throughout. Excess mortality in A(H1N1) and B seasons did not change. All-cause excess mortality for persons 65 years or older never exceeded 10{\%} of all winter deaths.Conclusions We attribute the decline in influenza-related mortality among people aged 65 to 74 years in the decade after the 1968 pandemic to the acquisition of immunity to the emerging A(H3N2) virus. We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10{\%} of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.",
author = "Lone Simonsen and Reichert, {Thomas A.} and Cecile Viboud and Blackwelder, {William C.} and Taylor, {Robert J.} and Mark Miller",
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Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population. / Simonsen, Lone; Reichert, Thomas A.; Viboud, Cecile; Blackwelder, William C.; Taylor, Robert J.; Miller, Mark.

I: Archives of Internal Medicine, Bind 165, Nr. 3, 2005.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Impact of Influenza Vaccination on Seasonal Mortality in the US Elderly Population

AU - Simonsen, Lone

AU - Reichert, Thomas A.

AU - Viboud, Cecile

AU - Blackwelder, William C.

AU - Taylor, Robert J.

AU - Miller, Mark

PY - 2005

Y1 - 2005

N2 - Background Observational studies report that influenza vaccination reduces winter mortality risk from any cause by 50% among the elderly. Influenza vaccination coverage among elderly persons (≥65 years) in the United States increased from between 15% and 20% before 1980 to 65% in 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period. We tried to reconcile these conflicting findings by adjusting excess mortality estimates for aging and increased circulation of influenza A(H3N2) viruses.Methods We used a cyclical regression model to generate seasonal estimates of national influenza-related mortality (excess mortality) among the elderly in both pneumonia and influenza and all-cause deaths for the 33 seasons from 1968 to 2001. We stratified the data by 5-year age group and separated seasons dominated by A(H3N2) viruses from other seasons.Results For people aged 65 to 74 years, excess mortality rates in A(H3N2)-dominated seasons fell between 1968 and the early 1980s but remained approximately constant thereafter. For persons 85 years or older, the mortality rate remained flat throughout. Excess mortality in A(H1N1) and B seasons did not change. All-cause excess mortality for persons 65 years or older never exceeded 10% of all winter deaths.Conclusions We attribute the decline in influenza-related mortality among people aged 65 to 74 years in the decade after the 1968 pandemic to the acquisition of immunity to the emerging A(H3N2) virus. We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10% of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.

AB - Background Observational studies report that influenza vaccination reduces winter mortality risk from any cause by 50% among the elderly. Influenza vaccination coverage among elderly persons (≥65 years) in the United States increased from between 15% and 20% before 1980 to 65% in 2001. Unexpectedly, estimates of influenza-related mortality in this age group also increased during this period. We tried to reconcile these conflicting findings by adjusting excess mortality estimates for aging and increased circulation of influenza A(H3N2) viruses.Methods We used a cyclical regression model to generate seasonal estimates of national influenza-related mortality (excess mortality) among the elderly in both pneumonia and influenza and all-cause deaths for the 33 seasons from 1968 to 2001. We stratified the data by 5-year age group and separated seasons dominated by A(H3N2) viruses from other seasons.Results For people aged 65 to 74 years, excess mortality rates in A(H3N2)-dominated seasons fell between 1968 and the early 1980s but remained approximately constant thereafter. For persons 85 years or older, the mortality rate remained flat throughout. Excess mortality in A(H1N1) and B seasons did not change. All-cause excess mortality for persons 65 years or older never exceeded 10% of all winter deaths.Conclusions We attribute the decline in influenza-related mortality among people aged 65 to 74 years in the decade after the 1968 pandemic to the acquisition of immunity to the emerging A(H3N2) virus. We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group. Because fewer than 10% of all winter deaths were attributable to influenza in any season, we conclude that observational studies substantially overestimate vaccination benefit.

U2 - 10.1001/archinte.165.3.265

DO - 10.1001/archinte.165.3.265

M3 - Journal article

VL - 165

JO - Archives of Internal Medicine

JF - Archives of Internal Medicine

IS - 3

ER -