Determinants of COVID-19 and Influenza Vaccination Among People with Diabetes Mellitus in Primary Health Care.

Background/

Objectives

People with diabetes are more susceptible to viral respiratory infections and worse clinical outcomes related to COVID-19 and influenza. Vaccination is considered an important prevention strategy. This study aimed to analyze the vaccination status against COVID-19 and influenza among people with diabetes mellitus and associated factors.

Methods

An analytical cross-sectional study was conducted between May 2024 and May 2025 in 42 Primary Health Care Units in a municipality in Minas Gerais, Brazil. A total of 316 individuals with type 1 or type 2 diabetes mellitus participated in the study. Data were collected using a structured instrument containing socioeconomic, cultural, behavioral, and clinical variables, in addition to verification of vaccination records through physical vaccination cards and information systems. Descriptive analyses and logistic regression models were performed to estimate crude and adjusted odds ratios, with respective 95% confidence intervals. Analyses were performed using Statistical Package for the Social Sciences and Stata.

Results

Adherence to COVID-19 vaccination was 21.5%, whereas influenza vaccination adherence reached 85.4%. In the multivariable analysis of COVID-19 vaccination status, previous influenza vaccination (OR = 7.74; 95% CI: 1.81-33.2) and alcohol consumption (OR = 2.11; 95% CI: 1.13-3.89) were positively associated with vaccination. Conversely, access to social media or other communication channels (OR = 0.47; 95% CI: 0.24-0.92) and insulin use (OR = 0.42; 95% CI: 0.21-0.84) were associated with lower odds of COVID-19 vaccination. Regarding influenza vaccination, positive associations were identified for religious affiliation (OR = 6.46; 95% CI: 1.79-23.30), previous COVID-19 vaccination (OR = 10.2; 95% CI: 2.22-47.06), and longer duration of diabetes diagnosis (OR = 3.47; 95% CI: 1.32-9.20). In contrast, alcohol consumption (OR = 0.42; 95% CI: 0.21-0.86), insulin use (OR = 0.35; 95% CI: 0.16-0.76), and absence of medical follow-up (OR = 0.34; 95% CI: 0.13-0.85) were associated with lower odds of influenza vaccination.

Conclusions

The findings revealed a heterogeneous vaccination pattern among individuals with diabetes mellitus, in which higher influenza vaccination coverage contrasted with low adherence to COVID-19 vaccination, reflecting not only differences in the historical consolidation of immunization strategies but also contemporary dynamics related to risk perception, trust, and information circulation. The strong association with previous vaccination history suggests that vaccine adherence is part of a continuum of preventive behaviors mediated by the relationship with healthcare services and by the internalization of healthcare practices over time.