{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T05:59:00Z","timestamp":1773813540330,"version":"3.50.1"},"reference-count":39,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T00:00:00Z","timestamp":1670198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Research, Development and Innovation Fund of Hungary","award":["TKP2020-NKA-04"],"award-info":[{"award-number":["TKP2020-NKA-04"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>In high-risk populations, such as the elderly or those with serious medical issues, for instance, people with cardiovascular diseases or diabetes, influenza can have devastating effects because it might contribute to severe complications or even death. This makes vaccination against influenza an essential component of public health. The primary objective of our research was to identify the characteristics that influenced whether an individual chose to become vaccinated against influenza, with an emphasis on whether they reported having diabetes. The data were obtained from the Hungarian implementation of the European Health Interview Surveys, which were conducted in 2009, 2014, and 2019. The total sample size was 15,874 people. To determine the variables that were related to vaccination, a multivariate logistic regression analysis that included interactions was performed. The overall vaccination coverage was 13% in 2009 and 12% in 2014 and 2019 among non-diabetic respondents; the coverage was 26% in 2009, 28% in 2014, and 25% in 2019 among diabetic respondents. Despite vaccination coverage in both groups being below the optimal level of 75%, we were able to identify factors influencing vaccination coverage. Among diabetic respondents, younger age, lower education level, sex, and co-morbidities were factors that influenced vaccination status. It is important for authorities managing healthcare and medical practitioners to be aware of the potential effects that influenza can have on diabetic patients; therefore, more efforts need to be made to increase the number of diabetic people receiving a vaccination against influenza.<\/jats:p>","DOI":"10.3390\/ijerph192316289","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T08:10:57Z","timestamp":1670227857000},"page":"16289","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Influenza Vaccination Coverage and Its Predictors among Self-Reported Diabetic Patients\u2014Findings from the Hungarian Implementation of the European Health Interview Survey"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4126-0058","authenticated-orcid":false,"given":"Gerg\u0151 J\u00f3zsef","family":"Sz\u0151ll\u0151si","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7370-440X","authenticated-orcid":false,"given":"Nguyen Chau","family":"Minh","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenifer","family":"Pataki","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5534-4404","authenticated-orcid":false,"given":"Cornelia Melinda","family":"Santoso","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attila Csaba","family":"Nagy","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4749-1057","authenticated-orcid":false,"given":"L\u00e1szl\u00f3","family":"Kardos","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,5]]},"reference":[{"key":"ref_1","unstructured":"(2022, November 21). Influenza (Seasonal). Available online: https:\/\/www.who.int\/health-topics\/influenza-seasonal."},{"key":"ref_2","unstructured":"(2022, November 21). About Chronic Diseases|CDC, Available online: https:\/\/www.cdc.gov\/chronicdisease\/about\/index.htm."},{"key":"ref_3","unstructured":"(2022, June 12). Diabetes. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/diabetes."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"177","DOI":"10.5001\/omj.2017.34","article-title":"Diabetes Mellitus: A Local and Global Public Health Emergency!","volume":"32","year":"2017","journal-title":"Oman Med. J."},{"key":"ref_5","unstructured":"(2022, November 21). Influenza and Diabetes|Influenza.com. Available online: https:\/\/www.influenza.com\/flu-and-diabetes\/."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7005a1","article-title":"Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices, United States, 2021\u201322 Influenza Season","volume":"70","author":"Grohskopf","year":"2021","journal-title":"MMWR Recomm. Rep."},{"key":"ref_7","unstructured":"CDC (2022, July 12). People at High Risk of Flu. Centers for Disease Control and Prevention, Available online: https:\/\/www.cdc.gov\/flu\/highrisk\/index.htm."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Remschmidt, C., Wichmann, O., and Harder, T. (2015). Vaccines for the prevention of seasonal influenza in patients with diabetes: Systematic review and meta-analysis. BMC Med., 13.","DOI":"10.1186\/s12916-015-0295-6"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"876","DOI":"10.2337\/diacare.13.8.876","article-title":"Influenza Infection and Diabetes Mellitus: Case for Annual Vaccination","volume":"13","author":"Diepersloot","year":"1990","journal-title":"Diabetes Care"},{"key":"ref_10","unstructured":"(2022, July 12). Estimated Flu-Related Illnesses, Medical visits, Hospitalizations, and Deaths in the United States\u20142019\u20132020 Flu Season|CDC 2021, Available online: https:\/\/www.cdc.gov\/flu\/about\/burden\/2019-2020.html."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.2337\/dc09-2215","article-title":"Diabetes and the Severity of Pandemic Influenza A (H1N1) Infection","volume":"33","author":"Allard","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kostova, D., Reed, C., Finelli, L., Cheng, P.-Y., Gargiullo, P.M., Shay, D.K., Singleton, J.A., Meltzer, M.I., Lu, P.-J., and Bresee, J.S. (2013). Influenza Illness and Hospitalizations Averted by Influenza Vaccination in the United States, 2005\u20132011. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0066312"},{"key":"ref_13","unstructured":"(2022, July 12). Flu & People with Diabetes|CDC, Available online: https:\/\/www.cdc.gov\/flu\/highrisk\/diabetes.htm."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3678","DOI":"10.1016\/j.vaccine.2021.05.011","article-title":"Does influenza vaccination attenuate the severity of breakthrough infections? A narrative review and recommendations for further research","volume":"39","author":"Ferdinands","year":"2021","journal-title":"Vaccine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"19741","DOI":"10.2807\/ese.15.49.19741-en","article-title":"Mortality of 2009 pandemic influenza A(H1N1) in Germany","volume":"15","author":"Wilking","year":"2010","journal-title":"Eurosurveillance"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.respe.2021.03.009","article-title":"Diabetes is a major cause of influenza-associated mortality in Mexico","volume":"69","author":"Noyola","year":"2021","journal-title":"Rev. D\u2019\u00e9pid\u00e9miologie St. Publique"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Shao, W., Li, X., Goraya, M.U., Wang, S., and Chen, J.-L. (2017). Evolution of Influenza A Virus by Mutation and Re-Assortment. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18081650"},{"key":"ref_18","unstructured":"(2022, May 08). CDC Seasonal Flu Vaccine Effectiveness Studies|CDC, Available online: https:\/\/www.cdc.gov\/flu\/vaccines-work\/effectiveness-studies.htm."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1017\/S095026889700825X","article-title":"Effectiveness of influenza vaccine in reducing hospital admissions in people with diabetes","volume":"119","author":"Colquhoun","year":"1997","journal-title":"Epidemiol. Infect."},{"key":"ref_20","unstructured":"(2022, November 21). VFC|Current CDC Vaccine Price List|CDC, Available online: https:\/\/www.cdc.gov\/vaccines\/programs\/vfc\/awardees\/vaccine-management\/price-list\/index.html."},{"key":"ref_21","unstructured":"(2022, November 21). Seasonal Influenza Vaccines Pricing|CMS, Available online: https:\/\/www.cms.gov\/Medicare\/Medicare-Fee-for-Service-Part-B-Drugs\/McrPartBDrugAvgSalesPrice\/VaccinesPricing."},{"key":"ref_22","unstructured":"(2022, July 12). Seasonal Influenza Vaccination and Antiviral Use in EU\/EEA Member States [Internet]. European Centre for Disease Prevention and Control. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/seasonal-influenza-vaccination-antiviral-use-eu-eea-member-states."},{"key":"ref_23","unstructured":"Influenza Vaccination Coverage Rates in the EU\/EEA (2022, July 21). European Centre for Disease Prevention and Control. Available online: https:\/\/www.ecdc.europa.eu\/en\/seasonal-influenza\/prevention-and-control\/vaccines\/vaccination-coverage."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"862","DOI":"10.46234\/ccdcw2020.229","article-title":"Overview and Lessons Learned for Increasing Influenza Vaccination Coverage Among Healthcare Workers in the United States","volume":"2","author":"Song","year":"2020","journal-title":"China CDC Wkly."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e000851","DOI":"10.1136\/bmjopen-2011-000851","article-title":"Strategies to increase influenza vaccination rates: Outcomes of a nationwide cross-sectional survey of UK general practice","volume":"2","author":"Dexter","year":"2012","journal-title":"BMJ Open"},{"key":"ref_26","unstructured":"(2022, November 21). European Health Interview Survey\u2014Methodology. Available online: https:\/\/ec.europa.eu\/eurostat\/statistics-explained\/index.php?title=European_health_interview_survey_-_methodology."},{"key":"ref_27","unstructured":"(2022, November 21). Eur\u00f3pai Lakoss\u00e1gi Eg\u00e9szs\u00e9gfelm\u00e9r\u00e9s. Available online: https:\/\/www.ksh.hu\/elef\/elozmenyek.html."},{"key":"ref_28","unstructured":"Influenza Elleni V\u00e9d\u0151olt\u00e1s (2022, July 21). Nemzetk\u00f6zi Olt\u00f3k\u00f6zpont. Available online: https:\/\/oltokozpont.hu\/hu\/oltas\/7\/influenza."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"930.e1","DOI":"10.1016\/j.cmi.2015.06.017","article-title":"Characteristics of patients and physicians correlated with regular influenza vaccination in patients treated for type 2 diabetes: A follow-up study from 2008 to 2011 in southeastern France","volume":"21","author":"Verger","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"363","DOI":"10.4161\/hv.18548","article-title":"Relationship between annual influenza vaccination and winter mortality in diabetic people over 65 years","volume":"8","author":"Valdivieso","year":"2012","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1080\/21645515.2020.1826250","article-title":"Barriers to influenza vaccination among different populations in Shanghai","volume":"17","author":"Yan","year":"2020","journal-title":"Hum. Vaccines Immunother."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Schmid, P., Rauber, D., Betsch, C., Lidolt, G., and Denker, M.L. (2017). Barriers of Influenza Vaccination Intention and Behavior\u2014A Systematic Review of Influenza Vaccine Hesitancy, 2005\u20132016. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0170550"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S114","DOI":"10.1093\/infdis\/jiu066","article-title":"Sex-based Biology and the Rational Design of Influenza Vaccination Strategies","volume":"209","author":"Klein","year":"2014","journal-title":"J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0002-9343(02)01421-3","article-title":"What affects influenza vaccination rates among older patients? An analysis from inner-city, suburban, rural, and veterans affairs practices","volume":"114","author":"Zimmerman","year":"2003","journal-title":"Am. J. Med."},{"key":"ref_35","unstructured":"CDC (2022, July 21). Flu & People 65 Years and Older. Centers for Disease Control and Prevention, Available online: https:\/\/www.cdc.gov\/flu\/highrisk\/65over.htm."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1080\/21645515.2018.1446719","article-title":"Immunogenicity, safety, and effectiveness of seasonal influenza vaccination in patients with diabetes mellitus: A systematic review","volume":"14","author":"Tahrat","year":"2018","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_37","unstructured":"(2022, July 21). Who Should not Get Vaccinated|CDC, Available online: https:\/\/www.cdc.gov\/vaccines\/vpd\/should-not-vacc.html."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e019636","DOI":"10.1161\/JAHA.120.019636","article-title":"Effects of Influenza Vaccine on Mortality and Cardiovascular Outcomes in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis","volume":"10","author":"Yedlapati","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e25142","DOI":"10.1097\/MD.0000000000025142","article-title":"The epidemiological and clinical characteristics of the hospital-acquired influenza infections: A systematic review and meta-analysis","volume":"100","author":"Li","year":"2021","journal-title":"Medicine"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/16289\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:34:26Z","timestamp":1760146466000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/23\/16289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,5]]},"references-count":39,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["ijerph192316289"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192316289","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,5]]}}}