Influenza vaccination, inverse care and homelessness: Cross-sectional survey of eligibility and uptake during the 2011/12 season in London

Alistair Story*, Robert W. Aldridge, Tat Gray, Stan Burridge, Andrew C. Hayward

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background: Influenza vaccination eligibility and uptake among homeless adults has not been previously assessed in the UK. This cross-sectional survey aimed to measure the proportion of homeless people visited by an NHS outreach service (Find and Treat) who were eligible for and had received vaccination during 2011/12. Methods. A cross-sectional survey was carried out in 27 separate homeless hostels, day centres and drug services in London between July and August in 2012. Eligibility for the survey was by virtue of being in attendance at one of 27 venues visited by Find and Treat. No specific exclusion criteria were used. Results: 455 clients took part in the survey out of 592 approached (76.9%). A total of 190 homeless people (41.8%; 95% CI: 34.5,50.5) were eligible for influenza vaccination. In those aged 16-64, eligibility due to clinical risk factors was 38.9% (95% CI: 31.5,48.2). Uptake of vaccination in homeless 16-64 year olds with a clinical risk factor during the 2011/12 influenza season was 23.7% (95% CI: 19.8,28.3) compared to national levels of 53.2% (excluding pregnant women). In those aged over 65, uptake was 42.9% (95% CI: 16.7,100.0) compared with 74.0% nationally. Conclusions: This study demonstrates that the homeless population have high levels of chronic health problems predisposing them to severe complications of influenza, but vaccine uptake levels that are less than half those seen among eligible GP patient groups in England. It provides a clear example of the health inequalities and inverse care law that impact this population. The results of this study provide strong justification for intensifying efforts to ensure homeless people have access to influenza vaccination.

Original languageEnglish
Article number44
JournalBMC Public Health
Issue number1
Publication statusPublished - 16 Jan 2014
Externally publishedYes

Bibliographical note

Funding Information:
This study was possible as a result of funding from Knowledge Into Action Registered Charity No. 1123566 with data management and analytical support provided through National Institute for Health Research Programme Grant For Applied Research (PGfAR RP-PG-0407-10340). The study funders had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Funding Information:
All authors have completed the Unified Competing Interest form (www. - available on request from the corresponding author) and declare: TG and SB had financial support from Knowledge Into Action Registered Charity No for support in completing submitted work; no other financial relationships exist with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities exist that could have influenced the submitted work. RWA was funded by a Wellcome Trust research training fellowship WT097980MA. AS is funded by UCLH Foundation Trust. AH is funded by Central and North West London NHS Foundation Trust.


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