142nd APHA Annual Meeting and Exposition

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311760
Association between Influenza Vaccination and Adverse Cardiovascular Outcomes in the Active Component, U.S. Armed Forces, 2008-2013

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Sunday, November 16, 2014

Shannon Blackmer, MD , Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD
Patricia Rohrbeck, DrPH, MPH, CPH , Division of Epidemiology & Analysis, Armed Forces Health Surveillance Center, Silver Spring, MD
Spencer Adams , Division of Epidemiology & Analysis, Team CNTS/GDIT, Armed Forces Health Surveillance Center, Silver Spring
Kerri Dorsey, MPH , Division of Epidemiology & Analysis, Team CNTS/GDIT, Armed Forces Health Surveillance Center, Silver Spring
Leslie Clark, PhD, MS , Division of Epidemiology & Analysis, General Dynamics Information Technology, Armed Forces Health Surveillance Center, Silver Spring, MD
Background: Influenza epidemics cause significant influenza-associated hospitalizations and deaths. Cardiovascular disease is a comorbidity that increases risk of influenza-related complications. Observational studies detected an increase in cardiovascular deaths during increased influenza activity. Recent studies suggest influenza vaccine is protective against cardiovascular events, even though no such studies were conducted in the U.S. military population. Service members are required to receive annual influenza vaccinations, yet the vaccination rate is less than 100 percent suggesting that unvaccinated individuals with cardiac risk factors may be at greater risk for adverse cardiac outcomes. As a result, this presentation will investigate the association between influenza vacciantion and adverse cardiac outcomes. 

METHODS: This retrospective cohort study utilized ICD-9-CM-based medical encounters in the Defense Medical Surveillance System (DMSS). The study population consisted of active component, U.S. Armed Forces service members (Army, Navy, Air Force, Marines, Coast Guard), 30 years and older. The surveillance period was 2008-2013 and included the five influenza seasons. The outcome, major adverse cardiac event (MACE), was defined as an inpatient encounter of MI, angina, heart failure, stroke, or other chronic ischemic heart disease. Multivariate logistic regression was used to assess the effect of influenza vaccination status and other covariates on MACE outcome. 

RESULTS: Overall, incidence of MACE was less than 1%, but higher in service members not vaccinated. All five influenza seasons showed a statistically significant protective association between influenza vaccination and MACE outcome. After adjusting for age, race/ethnicity, history of smoking, diabetes, hypertension, hyperlipidemia, and AFIB, the RR among those with influenza vaccination compared to those without ranged from 0.27 (95% CI: 0.21, 0.34) in season 2009-2012, to 0.55 (95% CI: 0.45, 0.67) in season 2011-2012.  

CONCLUSIONS: Influenza vacciantion was associated with a lower risk for MACE in service members 30 years and older in the active component, U.S. Armed Forces. This suggests that further education to medical personnel about potential benefits of influenza vaccine on cardiac outcomes is warranted in an effort to achieve full compliance with DoD vaccination requirements. Additionally, primary care and cardiology clinics should make influenza vaccines available to improve vaccination rates among those with cardiac risk factors.

Learning Areas:

Assessment of individual and community needs for health education
Chronic disease management and prevention
Epidemiology
Protection of the public in relation to communicable diseases including prevention or control
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe variations in influenza vaccinations and cardiovascular outcome by influenza season. Discuss variations in demographic characteristics and known risk factor for cardiovascular outcomes by influenza season. Identify risk factors for cardiovascular outcomes if no influenza vaccine was administered. Evaluate if there is an association between influenza vaccination and cardiovascular outcomes.

Keyword(s): Chronic Disease Prevention, Preventive Medicine

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a U.S. Navy medical provider completing a preventive medicine residency at the Uniformed Services University of the Health Sciences. While on active duty and during my residency, I conducted numerous epidemiological research studies and led annual influenza vaccination initiatives, and I am therefore qualified to be an abstract Author on this topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.