Public Health Unit Funding Per Capita and Seasonal Influenza Vaccination among Youth and Adults in Ontario, Canada in 2013/14 and 2018/19

• Author / Creator

  Chew, Jo Lin

• Background:
  Previous studies have indicated that public health funding was associated with beneficial health outcomes at the population-level. Some individuals may be less likely to vaccinate against influenza for a variety of reasons, including the presence of health inequities as a barrier. For example, individuals from a lower SES background, who are younger, and who are male may be less likely to get the flu vaccine. Few studies have focused on the potential impact of public health funding per capita on influenza vaccine uptake and inequities related to influenza vaccination at the individual level. The objectives of this study are to: 1) estimate the association between public health unit (PHU) funding per capita and influenza vaccine uptake among individuals aged 12 and older in Ontario, Canada in 2013/14 and 2018/19; and 2) determine whether any observed associations were heterogeneous across household income groups, gender, and age categories.

  Methods:
  Cross-sectional studies were conducted using the 2013/14 and 2018/19 cycles of the Canadian Community Health Survey (CCHS), a population-representative survey, by Statistics Canada that collects annual health data from individuals residing in local Ontario PHU service areas. PHU funding per capita was measured using the approved provincial funding for mandatory programs and the Canadian Census Population Estimates. Influenza vaccination in the past 12 months was measured by self-report in the CCHS. Multilevel logistic regression modelling was used to estimate the association between PHU funding per capita and self-reported influenza vaccine uptake, adjusting for gender, age, presence of chronic medication conditions, education, household income, presence of a regular medical doctor, urbanicity, self-perceived health, immigration status, and material deprivation. Cross-level interaction between PHU funding per capita and household income, and gender, and age were tested.

  Results:
  A case-complete weighted dataset of 10,780,494 and 10,653,927 CCHS respondents in 2013/14 and 2018/19, respectively were included in this study. The proportion of respondents who were vaccinated against influenza were 33.2% in 2013/14 and 35.5% in 2018/19. Across both years, among those who reported vaccination in the previous year, a higher proportion were female (54.8% for 2013/14; 55.8% for 2018/19), aged 20 to 49 years (30.7% for 2013/14; 33.0% for 2018/19), and from the highest household income group (50.4% for 2013/14; 66.5% for 2018/19). In 2013/14, an increase of one standard deviation (SD) in PHU funding was associated with having the influenza vaccine (OR: 1.08; 95% CI: 1.01, 1.15; SD: 14.1), which was not observed in 2018/19 (OR: 1.00; 95% CI: 0.93, 1.08; SD:14.4). A cross-level interaction between PHU funding per capita and household income further revealed that public health funding is protective among those from the lowest household income group and those between the ages of 50 and 64 years in 2013/14. Specifically, for every SD increase in PHU funding per capita, there is an increased likelihood of being vaccinated against influenza among individuals who belong to the lowest household income group (OR: 1.29; 95% CI: 1.10, 1.50) and those who are between the ages of 50 and 64 years (OR: 1.13; 95% CI: 1.03, 1.23) while adjusting for confounders. No heterogeneous associations were observed in 2018/19.

  Conclusion:
  PHU funding per capita was found to improve influenza vaccination uptake among individuals from low-income households and those who are between the ages of 50 and 64 years in 2013/14. Through funding, PHUs would be able to work towards their goal of preventing diseases, promoting health, and reducing health inequities among the population.

• Subjects / Keywords

  • Public health
  • Influenza vaccination
  • Infectious disease
  • Health inequities
  • Epidemiology
  • Social epidemiology

• Graduation date

  Fall 2023

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-0p1g-nj41

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.