Influenza, pneumococcal, COVID-19 vaccine willingness and uptake with influencing factors in 38,184 chinese older adults in 2022: a nationwide cross-sectional study.

OBJECTIVE: To assess the influenza, pneumococcal, and COVID-19 vaccine willingness and coverage profiles of Chinese older adults with their influencing factor, and to analyze differences across types and discrepancies between willingness and actual vaccination.

METHODS: A nationwide cross-sectional survey was conducted starting from September 2022 in China, including participants aged 60 years or older. Multi-stage stratified random sampling and on-site questionnaire surveys were carried out. The outcomes included the vaccine willingness and actual vaccination uptake of influenza, pneumococcal, and COVID-19 measured by questionnaire. Various multivariable logistics regressions were conducted to determine the influencing factors, and sensitivity analyses were conducted. The gap between uptake and willingness was based on the observed differences in determinants from multivariable analyses.

RESULTS: As of November 4, 2022, 38,184 eligible questionnaires were identified, with 53.97 % males and a median age of 68 years. The vaccination rate for COVID-19, influenza in previous season and pneumococcal was 85.86 %, 22.44 % and 7.72 %, while the willingness rates were 71.34 %, 73.84 % and 47.41 %. In multivariable logistic regression for vaccination, age was positively associated with influenza but negatively with COVID-19. Chronic comorbidity was positively associated with pneumococcal vaccination but negatively associated with COVID-19. Females had higher vaccination rates for both influenza and COVID-19. Participants with higher education levels had higher vaccination rates across all types. And willingness to be vaccinated was one of the strongest factors in promoting vaccination. Multivariable logistic regression in participants with willingness further confirmed attitudinal factors were still vital predictors of vaccination behavior. In addition, distinct regional patterns were observed for influenza and COVID-19 vaccination.

CONCLUSION: In the post-COVID-19 era, respiratory tract infections vaccine uptake and willingness among Chinese older adults vary. A gap persists between willingness and actual behavior, highlighting the need for coordinated strategies from healthcare institutions, researchers, and government to reduce vaccine hesitancy and enhance uptake.