Factors associated with influenza vaccination among urban community-dwelling Chinese elderly: results from a multicity cross-sectional study

To understand the influenza vaccination rates and factors associated with vaccination behavior of urban elder people in China. We performed a cross-sectional questionnaire study recruiting urban elder people from six cities in China between 9 December and 30 December 2024 in community. Demographics, knowledge about influenza, vaccination status, intention and reasons to receive or not receive the vaccine, and planning to be re-vaccinated were analyzed. Continuous and categorical variables were compared using unpaired z-test and Chi-square test, respectively. Potential confounders were adjusted using multiple logistic regression. 13363 urban elder people participated, with a mean age of 70 years, of which 54.7% were female, 15.4% in Chengdu, 16.3% of were in Beijing, 16.0% in Qingdao, 16.5% in Hangzhou, 16.9% in Shenzhen and 18.9% in Chongqing. The primary chronic conditions included hypertension, diabetes, hyperlipidemia, and stroke. The overall awareness rate of the influenza vaccine was 78.6%. Of the aware population, 40.3% received the vaccination and 78.8% were willing to be re-vaccinated. The overall vaccination rate was 34.0%, and 80.3 % were willing to be re-vaccinated. Higher education level (OR 1.40), higher income level (OR 1.52), marriage (OR 1.71), having health insurance (OR 1.72), having poor self-care ability (OR 1.30), having comorbidities (OR 1.18) were independently associated with influenza vaccination among older adults. Misconception of influenza, conformity with unvaccinated family or friends, and effectiveness and safety concerns of influenza vaccine were main barriers to influenza vaccination. The Government should improve influenza vaccination acceptance among elderly people through public education using diverse channels.