{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:13:07Z","timestamp":1790107987547,"version":"4.0.1"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"28th Batch of Science and Technology Development Plan (Applied Basic Research in Medical and Health Innovation) Youth Project of the Suzhou Bureau of Science and Technology","award":["SYW2024143"],"award-info":[{"award-number":["SYW2024143"]}]},{"award":["SYW2024143"],"award-info":[{"award-number":["SYW2024143"]}],"id":[{"id":"https:\/\/ror.org\/02q1n7w54","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"crossref","award":["NU2HJG000003-01-00"],"award-info":[{"award-number":["NU2HJG000003-01-00"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Influenza poses a serious threat to the health of older adults, and vaccination is a key strategy for prevention. As an economically developed city, Suzhou has a rapidly aging population, yet the influenza vaccination rate among older adults remains substantially lower than that in developed countries. There is an urgent need to understand the current vaccination status and its associated factors to inform future strategies for improving vaccination coverage. Objectives: To compare influenza- and vaccine-related knowledge, attitudes, practices, and information access channels between vaccinated and unvaccinated older adults (\u226560 years) in Suzhou, and to identify factors associated with vaccination behavior in economically developed areas. Methods: A comparative cross-sectional survey was conducted from April to August 2024 across six districts or county-level cities randomly selected from Suzhou\u2019s ten county-level administrative divisions. Participants were divided into vaccinated and unvaccinated groups based on their influenza vaccination status during the 2023\u20132024 influenza season. A two-stage sampling method was employed: the six districts were selected as primary sampling units; within each district, eligible older adults (aged \u226560 years) were randomly selected from two independent sampling frames\u2014the vaccination information system for the vaccinated group and the basic public health service system for the unvaccinated group. Face-to-face structured interviews were conducted using a questionnaire consisting of four sections; data were entered using EpiData 13.1 and analyzed using SPSS 27.0. The \u03c72 test, t-test, and multivariable logistic regression were used for statistical analysis. Results: Among 4622 valid older adults (vaccinated: n = 2007; unvaccinated: n = 2615), the vaccinated group scored significantly higher on influenza-related knowledge (4.06 \u00b1 2.21 vs. 3.16 \u00b1 2.33, p &lt; 0.001), vaccine-related knowledge (2.10 \u00b1 1.18 vs. 0.67 \u00b1 1.07, p &lt; 0.001), and perceived influenza risk scores (2.72 \u00b1 1.42 vs. 2.26 \u00b1 1.64, p &lt; 0.001). Vaccine safety and efficacy endorsement were also markedly higher among the vaccinated group (70.3% vs. 22.0%; 49.7% vs. 9.3%). Regarding information sources, the vaccinated group relied more on healthcare institutions (54.56% vs. 46.92%), whereas the unvaccinated group relied more on television (60.34% vs. 51.17%). Multivariable logistic regression revealed that awareness of the influenza vaccine (aOR = 9.151, 95%CI: 6.32\u201313.25), having a planned vaccination site (aOR = 2.66, 95%CI: 2.01\u20133.54), and perceiving the vaccine as safe (aOR = 1.81, 95%CI: 1.31\u20132.49) were positively associated with vaccination, while rural household registration (aOR = 0.76, 95%CI: 0.63\u20130.93), full-time employment (aOR = 0.41, 95%CI: 0.28\u20130.60), and hypertension (aOR = 0.79, 95%CI: 0.65\u20130.94) were inversely associated. Conclusions: Compared with the unvaccinated group, the vaccinated group demonstrated significantly better influenza- and vaccine-related knowledge, risk perception, and recognition of vaccine safety and efficacy, and relied more on healthcare institutions for information. Multivariable regression analysis identified awareness of the influenza vaccine as the strongest associated factor. These findings suggest that vaccination coverage could be improved by strengthening vaccine knowledge promotion through healthcare professionals and increasing awareness of vaccination policies that integrate medical insurance reimbursement.<\/jats:p>","DOI":"10.3390\/vaccines14070645","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T13:25:46Z","timestamp":1784726746000},"page":"645","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Influenza Vaccination Status and Associated Factors Among Older Adults in Suzhou, China: A Comparative Cross-Sectional Survey"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3323-8092","authenticated-orcid":false,"given":"Ningning","family":"Du","sequence":"first","affiliation":[{"name":"School of Public Health, Nanjing Medical University, Nanjing 211166, China"},{"name":"Suzhou Center for Disease Control and Prevention, Suzhou 215131, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Shao","sequence":"additional","affiliation":[{"name":"School of Public Health, Nanjing Medical University, Nanjing 211166, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Suzhou Center for Disease Control and Prevention, Suzhou 215131, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Liu","sequence":"additional","affiliation":[{"name":"Suzhou Center for Disease Control and Prevention, Suzhou 215131, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Pang","sequence":"additional","affiliation":[{"name":"Suzhou Center for Disease Control and Prevention, Suzhou 215131, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Hang","sequence":"additional","affiliation":[{"name":"Suzhou Center for Disease Control and Prevention, Suzhou 215131, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liling","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Public Health, Nanjing Medical University, Nanjing 211166, China"},{"name":"Suzhou Center for Disease Control and Prevention, Suzhou 215131, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"ref_1","unstructured":"Chinese Center for Disease Control and Prevention (2024). 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