Jürgen Maurer

Perceived seriousness of seasonal and A(H1N1) influenzas, attitudes toward vaccination, and vaccine uptake among U.S. adults: does the source of information matter?

OBJECTIVE We estimated uptake of seasonal and 2009 influenza A(H1N1) vaccine among U.S. adults and assessed their perceptions of the seriousness of both types of influenza and corresponding attitudes toward vaccination during the 2009-2010 influenza season. We further documented how vaccine uptake and attitudes varied by main information source used in vaccination decisions. METHODS We analyzed nationally representative data from U.S. adults age 18 and older (N=3,917) who completed an influenza vaccination survey between March 4th and March 24th, 2010. RESULTS 2009 influenza A(H1N1) vaccine uptake was considerably lower than seasonal vaccine uptake. While 2009 influenza A(H1N1) was perceived to be more serious than seasonal influenza, the pandemic vaccine was perceived to be less safe than the seasonal vaccine. Vaccine uptake and attitudes displayed large variation between adults who relied on different information sources for making their vaccination decisions. CONCLUSION The information launched during the response to the 2009 pandemic appear to have generated higher levels of concern about pandemic than seasonal influenza, but did not appear to reassure adults of the safety and value of the pandemic vaccine. Differences in perceived vaccination safety may be an important factor for explaining the lower uptake of pandemic relative to seasonal vaccine.

Does receipt of seasonal influenza vaccine predict intention to receive novel H1N1 vaccine: evidence from a nationally representative survey of U.S. adults.

We analyze data on the intention of U.S. adults to receive novel H1N1 vaccine if available this fall, and studies the relationship between the intention to be vaccinated against novel H1N1 and the uptake of seasonal influenza vaccine last year. We surveyed a nationally representative sample of U.S. adults (n=2067) via the Internet between May 26th and June 8th, 2009. Our results imply a vaccination rate for novel H1N1 of 49.6%, which corresponds to roughly 115 million adult vaccinations. Moreover, novel H1N1 vaccination intentions are strongly associated with seasonal influenza vaccinations, suggesting common attitudinal barriers to both vaccines.

The Effect of Retirement on Cognitive Functioning

Cognitive impairment has emerged as a major driver of disability in old age, with profound effects on individual well-being and decision making at older ages. In the light of policies aimed at postponing retirement ages, an important question is whether continued labour supply helps to maintain high levels of cognition at older ages. We use data of older men from the US Health and Retirement Study to estimate the effect of continued labour market participation at older ages on later-life cognition. As retirement itself is likely to depend on cognitive functioning and may thus be endogenous, we use offers of early retirement windows as instruments for retirement in econometric models for later-life cognitive functioning. These offers of early retirement are legally required to be nondiscriminatory and thus, inter alia, unrelated to cognitive functioning. At the same time, these offers of early retirement options are significant predictors of retirement. Although the simple ordinary least squares estimates show a negative relationship between retirement duration and various measures of cognitive functioning, instrumental variable estimates suggest that these associations may not be causal effects. Specifically, we find no clear relationship between retirement duration and later-life cognition for white-collar workers and, if anything, a positive relationship for blue-collar workers.

Racial and Ethnic Disparities in Uptake and Location of Vaccination for 2009-H1N1 and Seasonal Influenza

To learn more about racial and ethnic disparities in influenza vaccination during the 2009-H1N1 pandemic, we examined nationally representative survey data of US adults. We found disparities in 2009-H1N1 vaccine uptake between Blacks and Whites (13.8% vs 20.4%); Whites and Hispanics had similar 2009-H1N1 vaccination rates. Physician offices were the dominant location for 2009-H1N1 and seasonal influenza vaccinations, especially among minorities. Our results highlight the need for a better understanding of how communication methods and vaccine distribution strategies affect vaccine uptake within minority communities.

Height, education and later-life cognition in Latin America and the Caribbean

Building on previous evidence from the U.S., this study investigates the relationship between anthropometric markers (height and knee height), early-life conditions, education, and cognitive function in later life among urban elderly from Latin America and the Caribbean. I document a positive association between height and later-life cognitive function, which is larger for women than for men. This sex difference increases when I address potential feedback effects from mid- and later-life circumstances on stature by using knee height as an instrument for height. Specifically, while the estimates for women remain largely unchanged, I only find a diminished and statistically insignificant association between instrumented height and later-life cognition for men. This finding suggests that at least part of the association between height and later-life cognition among men may stem from common third factors that are correlated with both height and later-life cognition, such as adverse occupational exposures or health events during mid- and later life. Extended models that also include education further diminish the association between height and later-life cognition. Education displays strong positive gradients with the employed measures of childhood circumstances - including height - which points to education as a potential pathway linking early-life conditions and later-life cognitive function.

Education and Male-Female Differences in Later-Life Cognition: International Evidence From Latin America and the Caribbean

This study explores the role of early-life education for differences in cognitive functioning between men and women aged 60 and older from seven major urban areas in Latin America and the Caribbean. After documenting statistically significant differences in cognitive functioning between men and women for six of the seven study sites, I assess the extent to which these differences can be explained by prevailing male-female differences in education. I decompose predicted male-female differences in cognitive functioning based on various statistical models for later-life cognition and find robust evidence that male-female differences in education are a major driving force behind cognitive functioning differences between older men and women. This study therefore suggests that early-life differences in educational attainment between boys and girls during childhood have a lasting impact on gender inequity in cognitive functioning at older ages. Increases in educational attainment and the closing of the gender gap in education in many countries in Latin America and the Caribbean may thus result in both higher levels and a more gender-equitable distribution of later-life cognition among the future elderly in those countries.

Dental service utilization by Europeans aged 50 plus

OBJECTIVES To describe variations in the utilization of dental services by persons aged 50+ from 14 European countries and to identify the extent to which such variations are attributable to differences in oral health need and in accessibility of dental care. METHODS We use data from the Survey of Health, Ageing, and Retirement in Europe (SHARE Waves 2 and 3) and estimate a series of multivariate logistic regression models to analyze variations in dental service utilization (overall dental attendance, preventive treatment and/or operative treatment, dental attendance in early life years) RESULTS Overall dental attendance and incidence of solely preventive treatment are comparatively high in the Netherlands, Sweden, Denmark, Germany, and Switzerland. In contrast, overall dental attendance is relatively low in Spain, Italy, France, Greece, Poland, and Ireland. Moreover, a high incidence of solely operative treatment is observed in Austria, Italy, and France, whereas in the Netherlands, Sweden, Denmark, Switzerland, and Ireland, the incidence of solely operative treatment is comparably low. By and large, these variations persist even when controlling for cross-country differences in oral health need and in accessibility of dental care. CONCLUSIONS In comparison with other European regions, there is a tendency toward more frequent and preventive dental treatment of the elderly populations residing in Scandinavia and Western Europe. Such utilization patterns appear only partially attributable to differences in need for and accessibility of dental care.

Workplace Efforts to Promote Influenza Vaccination Among Healthcare Personnel and Their Association with Uptake During the 2009 Pandemic Influenza A (H1N1)

BACKGROUND Survey data suggest that, in a typical year, less than half U.S. healthcare personnel (HCP) are vaccinated for influenza. We measured workplace efforts to promote influenza vaccination among HCP in the U.S. and their association with seasonal and pandemic vaccination during the 2009-10 influenza season. METHODS Self-reported survey data collected in June 2010 from eligible HCP (n=1714) participating in a nationally representative, online research panel. HCP eligible for participation in the survey were those reporting as patient care providers and/or working in a healthcare setting. The survey measured workplace exposure to vaccination recommendations, vaccination requirements, on-site vaccination, reminders, and/or rewards, and being vaccinated for seasonal or H1N1 influenza. RESULTS At least two-thirds of HCP were offered worksite influenza vaccination; about one half received reminders; and 10% were required to be vaccinated. Compared to HCP in other work settings, hospital employees were most (p<0.001) likely to be the subject to efforts to promote vaccination. Vaccination requirements were associated with increases in seasonal and pandemic vaccination rates of between 31 and 49% points (p<0.005). On-site vaccination was associated with increases in seasonal and pandemic vaccination of between 13 and 29% points (p<0.05). Reminders and incentives were not associated with vaccination. CONCLUSIONS Our findings provide empirical support for vaccination requirements as a strategy for increasing influenza vaccination among HCP. Our findings also suggest that making influenza vaccination available to HCP at work could increase uptake and highlight the need to reach beyond hospitals in promoting vaccination among HCP.

Do People Who Intend to Get a Flu Shot Actually Get One

BACKGROUNDVaccination against seasonal influenza is far from universal among groups specifically recommended for vaccine. There is little research to guide communication with patients about vaccination.OBJECTIVETo assess the utility of the self-reported intention to be vaccinated against seasonal influenza in predicting vaccine uptake, reasons for being unvaccinated, and willingness to be vaccinated based on a doctor’s recommendation.METHODSWe analyzed data from a subset of respondents (n = 1,527) specifically recommended by the ACIP for vaccination against seasonal influenza who participated in two national surveys of adults age 18 and older conducted in November 2008 and March 2009.RESULTSOver half who intended to be vaccinated had been vaccinated. Compared to those without intentions, those with intentions were one-fifth as likely (p < 0.01) to cite lack of need and five times more likely (p < 0.01) to cite “not getting around to being vaccinated” as main reasons for not being vaccinated. Roughly two-fifths of those without the intention to be vaccinated indicated a willingness to be vaccinated based on a doctor’s recommendation.CONCLUSIONSAsking simple questions about the intention to be vaccinated against seasonal influenza may be an efficient means of identifying patients with whom extended discussion of vaccine benefits is warranted.

Contact and communication with healthcare providers regarding influenza vaccination during the 2009–2010 H1N1 pandemic

OBJECTIVE The existence of two vaccines-seasonal and pandemic-created the potential for confusion and misinformation among consumers during the 2009-2010 vaccination season. We measured the frequency and nature of influenza vaccination communication between healthcare providers and adults for both seasonal and 2009 influenza A(H1N1) vaccination and quantified its association with uptake of the two vaccines. METHODS We analyzed data from 4040 U.S. adult members of a nationally representative online panel surveyed between March 4th and March 24th, 2010. We estimated prevalence rates and adjusted associations between vaccine uptake and vaccination-related communication between patients and healthcare providers using bivariate probit models. RESULTS 64.1% (95%-CI: 61.5%-66.6%) of adults did not receive any provider-issued influenza vaccination recommendation. Adults who received a provider-issued vaccination recommendation were 14.1 (95%-CI: -2.4 to 30.6) to 32.1 (95%-CI: 24.3-39.8) percentage points more likely to be vaccinated for influenza than adults without a provider recommendation, after adjusting for other characteristics associated with vaccination. CONCLUSIONS Influenza vaccination communication between healthcare providers and adults was relatively uncommon during the 2009-2010 pandemic. Increased communication could significantly enhance influenza vaccination rates.