Exploring Factors Associated with Vaccine Uptake in a Single-Center Pulmonary Clinic Open Access
Verma, Divya (Spring 2026)
Abstract
Background: Patients with chronic lung disease are at increased risk of morbidity and mortality because of viral respiratory illnesses. As vaccines are an effective preventative health measure, we sought to evaluate factors associated with vaccine uptake in a chronic lung disease population using both quantitative and qualitative methodology.
Methods: This was a multimethod study combining retrospective quantitative analysis with prospective qualitative interviews. We used retrospective clinical data obtained from the EMR to assess the relationship between baseline lung function as defined by forced expiratory volume in one second percent predicted (FEV1 % predicted) and the odds of accepting a seasonal influenza vaccine. To complement our quantitative analysis, we performed in-depth interviews of patients living with chronic lung diseases to assess factors associated with accepting or declining influenza and COVID-19 vaccines.
Results: 1,927 unique participants were seen in 2,869 unique clinic visits. The population was primarily female (62%), Black (87%), non-Hispanic/Latino (94%) and obese (55%). A lower FEV1 % predicted was not associated with an increased odds of influenza vaccination. Older patients (≥ 65) and obese patients had a higher odds of influenza vaccination. Odds of vaccination decreased after the COVID-19 pandemic, with a sharp decline in OR of vaccination starting in the 2020 – 2021 influenza season. Eighteen semi-structured, in-depth interviews were conducted of participants with varying levels of vaccine hesitancy. Altruism and fear of severe disease due to underlying illness motivated vaccine acceptance, while medical mistrust was a strong driver of vaccine hesitancy.
Conclusions: FEV1% predicted was not significantly associated with an increased odds of influenza vaccination. Patients who were older and those who were obese were more likely to get a vaccine. Odds of vaccination declined significantly in the influenza season that immediately followed the beginning of the COVID-19 pandemic. Vaccine decision making is a complex, multi-faceted process shaped by risk perception, trust (and mistrust) and prior experiences with illness. Future efforts should be directed at vaccine counseling for those who are at increased risk of morbidity and mortality from viral infections, and vaccine education should continue to be prioritized in those who are chronically ill.
Table of Contents
Introduction: 1
Aim 1: 3
Methods: 3
Results: 5
Aim 2: 6
Methods: 6
Results: 8
Discussion: 9
Figures and tables 14
Figure 1. Pulmonary clinic visits and proportion of patients vaccinated for influenza at Grady between 2017 and 2023 14
Table 1. Study population characteristics 15
Table 2. Frequency table of visits by individual subjects 16
Table 3. Multilevel logistic regression examining the relationship between FEV1% predicted and likelihood of influenza vaccination 17
Table 4. Multilevel logistic regression examining the relationship between FEV1% predicted as generated using the internal reference equation and the likelihood of influenza vaccination: 18
Table 5. Multilevel logistic regression examining the relationship between FEV1% predicted as a continuous variable and the likelihood of influenza vaccination: 19
Table 6. Baseline characteristics of interview participants 20
Table 7. Qualitative Themes Related to Vaccine Perceptions and Behaviors 21
Table 8. Qualitative Themes Related to Vaccine Education 22
References: 23
About this Master's Thesis
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