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Low influenza and pneumococcal vaccination rates among patients with acute exacerbation of COPD are primarily driven by vaccine hesitancy stemming from complacency and a perceived lack of necessity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 1, 2025International Journal of COPD1 citationsOpen Access

Factors Associated with Influenza and Pneumococcal Vaccine Hesitancy Among Patients with AECOPD: A Cross-Sectional Study in China Using the 3C Model

YXYou XinChinese Academy of Medical Sciences & Peking Union Medical College RHR. HeShanxi University of Traditional Chinese Medicine XRXiaoxia RenCapital Medical University

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Abstract

Background and Aims: COPD patients are prioritized for influenza and pneumococcal vaccines, yet vaccination rates remain low, indicating vaccine hesitancy. This study aimed to investigate the vaccination rates and the underlying determinants of vaccine hesitancy, as the primary behavioral driver of low coverage, among patients hospitalized for Acute Exacerbation of COPD (AECOPD). Methods: From September 2022 to October 2023, 536 patients hospitalized due to AECOPD from eight hospitals in China were surveyed on their vaccination status (influenza or pneumococcal). Data on vaccination status and a structured 3C model (confidence, complacency, convenience) questionnaire were collected. Logistic regression identified factors associated with vaccination behavior, while structural equation modeling (SEM) elucidated the pathways through which the 3C components directly influence vaccine hesitancy. Results: The overall vaccination rate was 16.8% (90/536). Key factors associated with the vaccination behavior included high CAT score (aOR=5.64), pulmonary infection (aOR=2.28), former smoking (aOR=0.35), regular inhaled medication (aOR=0.47), high mMRC score (aOR=0.29), and bronchiectasis (aOR=0.40). Critically, the SEM analysis revealed that vaccine hesitancy was primarily driven by complacency, manifesting as a "lack of perceived need" (78%). This complacency was significantly influenced by a lack of confidence in vaccine safety and effectiveness, and compounded by convenience barriers like geographical inaccessibility and financial costs. The 3C model analysis quantified these relationships, with convenience (path coefficient=0.896) and confidence (0.375) positively impacting vaccination, while complacency showed a slight negative effect (-0.002). Conclusion: Low vaccination rates in AECOPD patients were mainly due to perceived lack of necessity, linked to vaccine hesitancy. This hesitancy was mainly driven by underestimation of disease severity. Integrated interventions are essential to improve vaccination uptake in this at-risk group.

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