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已发表论文
中国慢性阻塞性肺疾病急性加重患者对流感和肺炎球菌疫苗犹豫的相关因素：基于 3C 模型的横断面研究
Authors Xin Y, He R, Ren X, Yang T , Wang Y, Su X
Received 9 September 2025
Accepted for publication 22 December 2025
Published 28 December 2025 Volume 2025:20 Pages 4159—4171
DOI https://doi.org/10.2147/COPD.S566403
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Prof. Dr. Richard Russell
You Xin,1 Ruoxi He,1,2 Xiaoxia Ren,3– 6 Ting Yang,3– 6 Ye Wang,1,* Xiaoyou Su1,*
1School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 2Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China; 4Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China; 5National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China; 6National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ye Wang, Email wangye_pumc@163.com Xiaoyou Su, Email suxiaoyou@hotmail.com
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.
Keywords: chronic obstructive pulmonary disease, COPD, vaccine hesitancy, influenza and pneumococcal vaccine
1School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, People’s Republic of China; 2Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China; 4Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, 100029, People’s Republic of China; 5National Center for Respiratory Medicine, Beijing, 100029, People’s Republic of China; 6National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Ye Wang, Email wangye_pumc@163.com Xiaoyou Su, Email suxiaoyou@hotmail.com
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.
Keywords: chronic obstructive pulmonary disease, COPD, vaccine hesitancy, influenza and pneumococcal vaccine