流感疫苗及肺炎鏈球菌疫苗對高齡慢性阻塞性肺病患者的成效

Effectiveness of Influenza and Pneumococcal Vaccines on Elderly Patients with Chronic Obstructive Pulmonary Disease

目的：分析台灣地區75歲以上慢性阻塞性肺病（COPD）患者，其接種流感及肺炎鏈球菌疫苗型態，在呼吸系統相關疾病的醫療利用、醫療費用及成效差異。方法：採用回溯性世代研究設計，以75歲以上COPD患者為對象，採用全民健保承保抽樣歸人檔資料庫，擷取2011年10月1日至12月31日之流感及2007至2011年間肺炎鏈球菌疫苗接種記錄，依接種狀態區分為「未接種、僅流感疫苗、僅肺炎鏈球菌疫苗、兩種疫苗」四組，控制病患個人特質後，以線性迴歸、羅吉斯迴歸及負二項迴歸進行分析。結果：相較於未接種疫苗者，僅接種流感疫苗組，雖門診費用較高，但少30％之急診就醫；僅接種肺炎鏈球菌疫苗組，在各方面均無顯著差異；接種兩種疫苗組，雖有較高之門診就醫次數及費用，但急診就醫次數及費用均較低。結論：同時接種流感與肺炎鏈球菌疫苗之高齡COPD患者，其急診醫療資源使用較低，建議高齡COPD患者應同時接種兩種疫苗。 Purposes To analyze the effects of influenza and pneumococcal vaccinations on senior citizens aged 75 years and above with chronic obstructive pulmonary disease (COPD) in Taiwan in terms of medical utilization, expenditure, and differences in effectiveness for respiratory diseases. Methods We conducted a retrospective cohort study on COPD patients aged 75 years and above as the study subjects. The Longitudinal Health Insurance Database (LHID) under the National Health Insurance Research Database that was maintained by the National Health Research Institutes, Taiwan, was used to extract influenza vaccination records from October 1 to December 31, 2011 and pneumococcal vaccination records from 2007 to 2011. Subjects were divided into four groups, based on their vaccination status: received influenza vaccination only, received pneumococcal vaccination only, received both vaccinations, and unvaccinated. After controlling for individual characteristics, we conducted an analysis using linear regression, logistic regression, and negative binomial regression. Results Compared with the unvaccinated group, subjects who received only the influenza vaccination had higher outpatient expenditure, however, their emergency department utilization were 30% lower; subjects who received only the pneumococcal vaccination did not show any significant difference in various aspects; subjects who received both vaccinations had a lower number of emergency department visits and less expenditure, even though they had a higher number of outpatient visits and high expenditure. Conclusions Elderly COPD patients who received concomitant influenza and pneumococcal vaccinations showed lower utilization of emergency medical resources. We recommend that elderly COPD patients receive concomitant influenza and pneumococcal vaccinations.

Purposes To analyze the effects of influenza and pneumococcal vaccinations on senior citizens aged 75 years and above with chronic obstructive pulmonary disease (COPD) in Taiwan in terms of medical utilization, expenditure, and differences in effectiveness for respiratory diseases. Methods We conducted a retrospective cohort study on COPD patients aged 75 years and above as the study subjects. The Longitudinal Health Insurance Database (LHID) under the National Health Insurance Research Database that was maintained by the National Health Research Institutes, Taiwan, was used to extract influenza vaccination records from October 1 to December 31, 2011 and pneumococcal vaccination records from 2007 to 2011. Subjects were divided into four groups, based on their vaccination status: received influenza vaccination only, received pneumococcal vaccination only, received both vaccinations, and unvaccinated. After controlling for individual characteristics, we conducted an analysis using linear regression, logistic regression, and negative binomial regression. Results Compared with the unvaccinated group, subjects who received only the influenza vaccination had higher outpatient expenditure, however, their emergency department utilization were 30% lower; subjects who received only the pneumococcal vaccination did not show any significant difference in various aspects; subjects who received both vaccinations had a lower number of emergency department visits and less expenditure, even though they had a higher number of outpatient visits and high expenditure. Conclusions Elderly COPD patients who received concomitant influenza and pneumococcal vaccinations showed lower utilization of emergency medical resources. We recommend that elderly COPD patients receive concomitant influenza and pneumococcal vaccinations.