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Clinic accessibility and clinic-level predictors of the geographic variation in 2009 pandemic influenza vaccine coverage in Montreal, Canada.

Abstract：

BACKGROUND:Nineteen mass vaccination clinics were established in Montreal, Canada, as part of the 2009 influenza A/H1N1p vaccination campaign. Although approximately 50% of the population was vaccinated, there was a considerable variation in clinic performance and community vaccine coverage. OBJECTIVE:To identify community- and clinic-level predictors of vaccine uptake, while accounting for the accessibility of clinics from the community of residence. METHODS:All records of influenza A/H1N1p vaccinations administered in Montreal were obtained from a vaccine registry. Multivariable regression models, specifically Bayesian gravity models, were used to assess the relationship between vaccination rates and clinic accessibility, clinic-level factors, and community-level factors. RESULTS:Relative risks compare the vaccination rates at the variable's upper quartile to the lower quartile. All else being equal, clinics in areas with high violent crime rates, high residential density, and high levels of material deprivation tended to perform poorly (adjusted relative risk [ARR]: 0·917, 95% CI [credible interval]: 0·915, 0·918; ARR: 0·663, 95% CI: 0·660, 0·666, ARR: 0·649, 95% CI: 0·645, 0·654, respectively). Even after controlling for accessibility and clinic-level predictors, communities with a greater proportion of new immigrants and families living below the poverty level tended to have lower rates (ARR: 0·936, 95% CI: 0·913, 0·959; ARR: 0·918, 95% CI: 0·893, 0·946, respectively), while communities with a higher proportion speaking English or French tended to have higher rates (ARR: 1·034, 95% CI: 1·012, 1·059). CONCLUSION:In planning future mass vaccination campaigns, the gravity model could be used to compare expected vaccine uptake for different clinic location strategies.

journal_name

Influenza Other Respir Viruses

journal_title

Influenza and other respiratory viruses

authors

Charland KM,de Montigny L,Brownstein JS,Buckeridge DL

doi

10.1111/irv.12227

subject

Has Abstract

pub_date

2014-05-01 00:00:00

pages

317-28

issue

eissn

1750-2640

issn

1750-2659

journal_volume

pub_type

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Clinic accessibility and clinic-level predictors of the geographic variation in 2009 pandemic influenza vaccine coverage in Montreal, Canada.