Abstract
Background: Preventing and reducing acute exacerbations is a key objective in chronic obstructive pulmonary disease (COPD) management. Therefore, vaccination against influenza and pneumococcal disease is particularly important for this population. Under self-funded vaccination policies, the coverage rates for both vaccines among COPD patients in China are critically low. Since 2013, Shanghai has implemented a program providing one free dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to residents aged 60 and above, whereas influenza vaccination remains self-funded. Few studies have compared influenza and pneumococcal vaccination coverage among COPD patients in China under these distinct funding strategies. Methods: This study used a stratified cluster sampling method to select COPD patients registered in the "Shanghai Community Chronic Disease Health Management System" from both urban (Xuhui) and suburban (Fengxian) districts of Shanghai. Data on demographic characteristics, medical history, physical examination results, behavioral risk factors, and vaccination records were extracted from the system. Vaccination records were verified using the "Shanghai Immunization Information System". Descriptive analysis was conducted to assess influenza vaccine (self-funded, InfV) coverage during the 2023/2024 influenza season and cumulative PPV23 (government-funded) vaccination coverage among COPD patients. Logistic regression analysis was further employed to identify potential factors associated with InfV and PPV23 vaccination uptake in this population. Results: During the 2023/2024 influenza season, the influenza vaccination coverage under a self-funded policy was 5.87% among 1601 COPD patients in Shanghai, while the cumulative coverage of PPV23 under the government-funded program reached 52.15%. The willingness to receive PPV23 (60.40% vs. 27.55%; χ(2) = 350.73, p < 0.001) and the uptake among willing individuals (86.35% vs. 21.32%; χ(2) = 570.69, p < 0.001) were significantly higher under the free strategy compared to the self-funded InfV. For both vaccines, the primary reason for vaccine hesitancy was concern about adverse reactions, cited by over 50% of unwilling COPD patients. Multivariate analysis identified urban residence (aOR = 4.47, 95%CI: 2.86-6.98), prior PPV23 vaccination (aOR = 6.00, 95%CI: 3.43-10.49) and prior COVID-19 vaccination (aOR = 3.18, 95%CI: 1.79-5.66) as positive predictors of self-funded influenza vaccination. For PPV23 vaccination under the government-funded policy, significant factors included prior influenza vaccination (aOR = 6.89, 95%CI: 4.68-10.12), advanced age (aOR = 4.73, 95%CI: 3.68-6.09), and suburban residence (aOR = 0.37, 95%CI: 0.29-0.47). Conclusions: Influenza vaccination coverage among COPD patients in Shanghai remains critically low compared to the government-funded PPV23, highlighting the pivotal role of public funding. To address this disparity, urgent policy measures, including incorporating the influenza vaccine into publicly funded or health insurance reimbursement schemes, are essential.