Sociodemographic, health and behavioral factors associated with influenza vaccination uptake among patients with diabetes in Singapore: A cohort registry-based study.

Objective: With the low uptake of influenza vaccination among patients with diabetes mellitus in many countries, this study aims to investigate how sociodemographic, health and behavioral factors collectively predict vaccination uptake among patients in Singapore. Methods: A retrospective study was conducted using the SingHealth Diabetes Registry. Patients aged 21 and above with diabetes mellitus from 2013 onwards were selected. Data on demographic and clinical characteristics, attendance at eye and foot screenings, smoking status, and influenza vaccination records from 2013 to 2020 were analyzed with the Prentice, William and Peterson Gap Time model and binomial logistic regression. Results: A total of 184,882 patients, contributing 1,106,085 influenza vaccination records from 2013 to 2020 were analyzed. Age, ethnicity, housing type, duration of diabetes, and attendance at eye or foot screenings were associated with receiving at least one vaccination and with regular annual vaccinations over an eight-year period. Compared to patients without complications screening, those who underwent eye and foot screenings were 1.19 times (95 % CI 1.16, 1.22) and 1.20 times (95 % CI 1.18, 1.23) more likely, respectively, to have received at least one vaccination. They were also 1.41 times (95 % CI 1.20, 1.66) and 1.45 times (95 % CI 1.23, 1.70) more likely, respectively, to have received regular vaccination. Conclusions: Attendance at eye and foot screenings among patients with diabetes mellitus was associated with higher influenza vaccination uptake, both at least once and annually. Bundling influenza vaccination with eye and foot screenings may improve vaccination uptake at the population level.