Factors Associated with Influenza and Pneumococcal Vaccine Hesitancy Among Patients with AECOPD using the 3C Model: A Cross-Sectional Study in China

Background and Aims : COPD patients are prioritized for influenza and pneumococcal vaccines, yet vaccination rates remain low, indicating vaccine hesitancy. This study evaluates vaccination status in AECOPD patients and identifies associated factors. Methods From September 2022 to October 2023, 536 patients hospitalized due to AECOPD from eight hospitals in China were surveyed on their vaccination status (influenza or pneumococcal). Logistic regression was used to identify demographic and clinical factors associated with vaccination. Vaccine hesitancy was assessed using the 3C model (confidence, convenience, complacency). Structural equation modeling was used to examine the relationship between the 3C model and vaccination status. Results The influenza or pneumococcal vaccination rate among AECOPD patients was 16.8% (90/536). Factors negatively correlated with higher vaccination rates include a high CAT score (aOR = 5.64) and pulmonary infection (aOR = 2.28), whereas former smoking (aOR = 0.35), regular inhaled medication (aOR = 0.47), a high mMRC score (aOR = 0.29), and bronchiectasis (aOR = 0.40) are positively correlated with higher vaccination rates. The top reasons for vaccine hesitancy were lack of perceived need (78%), lack of awareness of vaccination sites (27%), and vaccine safety concerns (13%). In the 3C model, convenience (0.896) and confidence (0.375) had a positive impact on vaccination, while complacency had a slight negative effect (-0.002). Patients with severe symptoms often reported "geographical inaccessibility" and "financial barriers" as vaccination deterrents. "Lack of perceived need" was negatively correlated with the other 3C factors, particularly vaccine safety concerns. Among individuals perceiving no need for vaccination, 33% questioned vaccine effectiveness, while 42% underestimated disease severity. Conclusion Low vaccination rates in AECOPD patients were mainly due to perceived lack of necessity, linked to vaccine hesitancy. This hesitancy was mainly driven by underestimation of disease severity. Integrated interventions are essential to improve vaccination uptake in this at-risk group.