Factors Associated With Non-vaccination for Influenza Among Patients With CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Rationale & Objective: Vaccination for influenza is strongly recommended for people with chronic kidney disease (CKD) due to their immunocompromised state. Identifying risk factors for not receiving an influenza vaccine (non -vaccination) could inform strategies for improving vaccine uptake in this high -risk population. Study Design: Longitudinal observational study. Setting & Participants: 3,692 Chronic Renal Insufficiency Cohort Study (CRIC) participants. Exposure: Demographic factors, social determinants of health, clinical conditions, and health behaviors. Outcome: Influenza non -vaccination, which was assessed based on a receipt of influenza vaccine ascertained during annual clinic visits in a subset of participants who were under nephrology care. Analytical Approach: Mixed -effects Poisson models to estimate adjusted prevalence ratios (APRs). Results: Between 2009 and 2020, the pooled mean vaccine uptake was 72% (mean age, 66 years; 44% female; 44% Black race). In multivariable models, factors significantly associated with influenza non -vaccination were younger age (APR, 2.16 [95% CI, 1.85-2.52] for <50 vs >= 75 years), Black race (APR, 1.58 [95% CI, 1.431.75] vs White race), lower education (APR, 1.20 [95% CI, 1.04-1.39 for less than high school vs college graduate]), lower annual household income (APR, 1.26 [95% CI, 1.061.4 9] for <$20,000 vs >$100,000), formerly married status (APR, 1.22 [95% CI, 1.0 9-1.35] vs currently married), and nonemployed status (APR, 1.13 [95% CI, 1.02-1.24] vs employed). In contrast, participants with diabetes (APR, 0.80 [95% CI, 0.73-0.87] vs no diabetes), chronic obstructive pulmonary disease (COPD) (APR, 0.80 [95% CI, 0.70-0.92] vs no COPD), end -stage kidney disease (APR, 0.64 [0.56 to 0.76] vs estimated glomerular filtration rate >= 60 mL/min/1.73 m(2)), frailty (APR, 0.86 [95% CI, 0.74-0.9 9] vs no frailty), and ideal physical activity (APR, 0.90 [95% CI, 0.82-0.9 9] vs. physically inactive) were less likely to have non -vaccination status. Limitations: Possible residual confounding. Conclusions: Among adults with CKD receiving nephrology care, younger adults, Black individuals, and those with adverse social determinants of health were more likely to have the influenza non -vaccination status. Strategies are needed to address these disparities and reduce barriers to vaccination.