Understanding the value of vaccination for improving health equity in older adults: The role of the social determinants of health for vaccine preventable diseases

Details

Supervisors

Tubeuf, Sandy ; Beck, Ekkehard

Faculty

Faculté de santé publique

Degree label

Master [120] en sciences de la santé publique, à finalité spécialisée

Abstract

This work aimed to better understand the value of vaccination in health technology assessment (HTA) in terms of social equity. To support ongoing reflection on the suitable health equity criteria to be used for decision making in HTA on vaccines and to identify the social inequities that vaccination might reduce or erase, the role of social determinants of health in susceptibility to vaccine-preventable diseases has been investigated. Focus was made on the population of older adults of 50 years old and above in North-Western, high-income countries. This master thesis gathers together a targeted literature review, which aims to identify the determinants of health impacting respiratory infectious disease caused by Influenza virus, Streptococcus Pneumoniae and/or Respiratory Syncytial virus in older adults, and an empirical investigation of how the social determinants of health may impact the incidence of infectious diseases using an insurance claim database. Socio-economic status seems to be a determinant of health of major importance in context of respiratory disease in older adults. The more socio-economically deprived groups are more sensitive to these infectious diseases which may be explained by their poorer health status and because they have less opportunity to access to healthcare and preventable measures. This condition might be further exacerbated by the fact that they live in areas more exposed to air pollutants, with less resource to protect themselves against pollution hazard. They also tend to have more unhealthy behaviors like smoking and to be more negatively affected by alcohol consumption. Their increased susceptibility to infectious might be caused by multiple factors, including a lower vaccination uptake. Age should be considered too as determinant of health in the older adult population. Despite an increased compliance to vaccination with age, susceptibility to infectious disease increases in the oldest. Their frailty condition and some related intermediary determinants of health like the living conditions in nursing home may further impact susceptibility of the oldest ones. There is no consensus in the literature on the potential impact of race/ethnicity and gender on susceptibility to infectious diseases. Social capital, socio-economic status and living conditions may be confounding factors that triggers the variability in these observations. Overall, this work highlights the complex interplay between multiple structural and intermediary determinants of health which may re-enforce each other’s in defining susceptibility to respiratory infectious disease in older adults. It emphasizes the need to define a common framework to support equity assessment in future HTA and public health decision making.