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In this study, we study the coverage and factors associated with vaccination uptake, as well as refusal in the unvaccinated population and their associations with ethnicity, deprivation, household size and health conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participants<\/jats:title>\n                    <jats:p>This is a cross-sectional study of adults aged 65 years or older in England, using a large primary care database. Associations of vaccine uptake and refusal in the unvaccinated with ethnicity, deprivation, household size and health conditions were modelled using multivariable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measure<\/jats:title>\n                    <jats:p>Influenza, pneumococcal and shingles vaccine uptake and refusal (in the unvaccinated).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This study included 2 054 463 patients from 1318 general practices. 1\u2009711\u2009465 (83.3%) received at least one influenza vaccine, 1\u2009391\u2009228 (67.7%) pneumococcal vaccine and 690\u2009783 (53.4%) shingles vaccine. Compared with White ethnicity, influenza vaccine uptake was lower in Chinese (OR 0.49; 95%\u2009CI 0.45 to 0.53), \u2018Other ethnic\u2019 groups (0.63; 95% CI 0.60 to 0.65), black Caribbean (0.68; 95% CI 0.64 to 0.71) and black African (0.72; 95% CI 0.68 to 0.77). There was generally lower vaccination uptake among more deprived individuals, people living in larger household sizes (three or more persons) and those with fewer health conditions. Among those who were unvaccinated, higher odds of refusal were associated with the black Caribbean ethnic group and marginally with increased deprivation, but not associated with higher refusal in those living in large households or those with lesser health conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Certain ethnic minority groups, deprived populations, large households and 'healthier' individuals were less likely to receive a vaccine, although higher refusal was only associated with ethnicity and deprivation but not larger households nor healthier individuals. Understanding these may inform tailored public health messaging to different communities for equitable implementation of vaccination programmes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-058705","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T10:56:16Z","timestamp":1678964176000},"page":"e058705","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Factors influencing influenza, pneumococcal and shingles vaccine uptake and refusal in older adults: a population-based cross-sectional study in England"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3359-1874","authenticated-orcid":false,"given":"Pui San","family":"Tan","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5954-1045","authenticated-orcid":false,"given":"Martina","family":"Patone","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0061-979X","authenticated-orcid":false,"given":"Ashley Kieran","family":"Clift","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajira","family":"Dambha-Miller","sequence":"additional","affiliation":[{"name":"Primary Care Research Centre, University of Southampton Faculty of Medicine, Southampton, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Defne","family":"Saatci","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3091-2337","authenticated-orcid":false,"given":"Tom A","family":"Ranger","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7073-3611","authenticated-orcid":false,"given":"Cesar","family":"Garriga","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Zaccardi","sequence":"additional","affiliation":[{"name":"University of Leicester, Leicester, UK"},{"name":"Diabetes Research Centre, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baiju R","family":"Shah","sequence":"additional","affiliation":[{"name":"Sunnybrooke Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Coupland","sequence":"additional","affiliation":[{"name":"Division of Primary Care, University of Nottingham, Nottingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon J","family":"Griffin","sequence":"additional","affiliation":[{"name":"The Primary Care Unit, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamlesh","family":"Khunti","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre, University of Leicester, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2479-7283","authenticated-orcid":false,"given":"Julia","family":"Hippisley-Cox","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"2025121221461059000_13.3.e058705.1","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1038\/s43587-021-00114-7","article-title":"SARS-cov-2, COVID-19 and the ageing immune system","volume":"1","author":"Bartleson","year":"2021","journal-title":"Nat Aging"},{"key":"2025121221461059000_13.3.e058705.2","unstructured":"Public Health England . 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