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

Background

Influenza vaccination reduces morbidity and mortality in older adults. This study identifies characteristics and reasons for vaccination uptake among the elderly to inform strategies to improve coverage. Methods: We conducted a cross-sectional survey in December 2024 among community-dwelling adults aged ≥60 years across six Chinese cit-ies. Data collected included socio-demographic and health characteristics, influenza vac-cine awareness and uptake, reasons for vaccination or non-vaccination, and intentions for future vaccination. Univariate and multivariable logistic regression was used to identify factors associated with vaccination. To explore motivation patterns, co-occurrence net-works of vaccination reasons were constructed, and k-medoids clustering was applied. Results: Among 13,363 adults aged ≥60 years, influenza vaccination coverage was 34.0%. Higher education and income, being married, having health insurance, poor self-care ability, and chronic obstructive pulmonary disease were independently associated with vaccination. Vaccinated individuals reported more positive attitudes and were mainly motivated by family and doctor recommendations as well as perceived vaccine effective-ness, with four motivation profiles: social recommendation, comprehensive confidence, clinician-guided, and self-reliant confidence. Among unvaccinated participants, the main reasons for non-vaccination were mild influenza symptoms and the influence of family and friends, forming four motivation profiles: safety concern, low-perceived risk, social in-fluence, and perceived ineffectiveness. Conclusions: Influenza vaccination among older Chinese adults remains suboptimal. Tailored interventions leveraging healthcare provider endorsement, family and social support, and policy-driven strategies such as free or subsidized vaccination are needed, particularly for high-risk populations.