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Influenza vaccination reduces dementia in patients with chronic obstructive pulmonary disease: a nationwide cohort study
  1. Ching-Shan Luo1,2,
  2. Ching-Chi Chi3,4,
  3. Yu-Ann Fang5,
  4. Ju-Chi Liu5,6,
  5. Kang-Yun Lee1,7
  1. 1Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
  2. 2International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  3. 3Department of Dermatology, Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
  4. 4College of Medicine, Chang Gung University, Taoyuan, Taiwan
  5. 5Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
  6. 6Division of Cardiovascular Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  7. 7Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  1. Correspondence to Professor Kang-Yun Lee, Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei City 23561, Taiwan; leekangyun{at}tmu.edu.tw; Professor Ju-Chi Liu, Division of Cardiovascular Medicine, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City 23561, Taiwan; liumdcv{at}tmu.edu.tw

Abstract

This study aimed to explore the protective potential of influenza vaccination against occurrence of dementia in patients with chronic obstructive pulmonary disease (COPD), who are expected to be more vulnerable to influenza infection. This nationwide retrospective cohort study enrolled patients with COPD (aged ≥60 years) from 1 January 2001 to 31 December 2012 by using the Taiwan National Health Insurance Research Database. By applying time-dependent Cox proportional hazard model, we used multivariate analysis to calculate the adjusted HR (aHR) with 95% CI of dementia in relation to influenza vaccination among patients with COPD. Besides, patients were partitioned into four groups according to the vaccination number (unvaccinated, 1, 2–3 and ≥4 total vaccinations) to investigate the dose-response effect of vaccinations on the dementia incidence. This cohort study included 19 848 patients with COPD, and 45% of them received influenza vaccination. The aHR of dementia was 0.68 (95% CI: 0.62 to 0.74, p<0.001) comparing vaccinated patients with unvaccinated ones. Furthermore, there was a trend of dementia risk reduction with the vaccination number. For patients who received 2–3 vaccinations, the aHR was 0.81 (95% CI: 0.73 to 0.90), and for those received 4 vaccinations, the aHR was 0.44 (95% CI: 0.40 to 0.50), with p for trend <0.001. In conclusion, annual influenza vaccination can reduce the risk of dementia in patient with COPD in a dose-dependent manner.

  • chronic obstructive pulmonary disease
  • dementia
  • influenza vaccination
  • frequent exacerbation
  • dose effect
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Footnotes

  • Contributors J-CL and K-YL were involved in the conception and design of the study. C-SL and Y-AF contributed to data acquisition and analysis. C-SL drafted the manuscript. C-CC, J-CL and K-YL provided the final revision. All authors provided final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study design was approved by Taipei Medical University Joint Institutional Review Board (N201708051).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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