Rezaei, Satar and Karami Matin, Behzad and Najafi, Farid and Ahmadi, Sina and Heidarzadeh Arani, Amahtis and Brown, Heather (2025) Navigating the crossroads of health and wealth : socioeconomic inequality in flu vaccination uptake among the elderly in Iran. BMC Geriatrics. ISSN 1471-2318 (In Press)
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Abstract
Background: There is limited evidence regarding socioeconomic-related inequalities in flu vaccination uptake among the elderly in developing countries like Iran. This study aims to examine these inequalities and identify the main determinants of observed inequalities among the elderly in Iran. Method: In this cross-sectional study, we collected data on sociodemographic factors, economic status, flu vaccination history, and reasons for receiving or declining the vaccine among 1,192 individuals aged 60 years and older through multistage sampling in 2024. Monthly household expenditures were used as a proxy to measure the economic status of the participants' households. We initially employed multiple logistic regression to assess the main factors affecting flu vaccination uptake among the samples. Subsequently, we utilized the concentration curve (CC) and concentration index (CI), specifically Wagstaff normalized CI and Erreygers normalized CI, to illustrate and quantify socioeconomic inequalities in flu vaccination uptake. Additionally, decomposition analysis was conducted to identify primary determinants of economic-related inequality in flu vaccination. Results: This study found that the prevalence of flu vaccination uptake among the elderly was 29.69% (n=354) for the current or previous flu season and 40.81% (n=486) for having ever received a flu vaccination at any time in their lives. Key factors influencing vaccination included education level, monthly household expenditures, consultations with health professionals, trust in healthcare providers, and prior vaccination history. Both Wagstaff normalized CI and Erreygers normalized CI indicated that vaccination distribution was disproportionately concentrated among wealthier groups. Decomposition analysis revealed that flu vaccination history (101.1%), household costs (21.3%), consultations regarding flu vaccination from health centers or professionals (13.6%), trust in health professionals concerning flu vaccination (12.4%), and education level (7.9%). were significant determinants of observed inequalities. Conclusion: This study highlights significant socioeconomic inequalities in flu vaccination uptake among the elderly in Iran, indicating that wealthier individuals are more likely to receive vaccinations. Addressing these disparities through targeted interventions is essential for improving vaccination rates and overall public health outcomes among vulnerable populations.