Vaccine hesitancy primarily consists of confidence, complacency, and convenience, including geographical accessibility. However, few studies in developed countries have focused on the association between geographical accessibility to vaccination services and vaccination status and previous studies have shown conflicting results. This cross-sectional study aimed to clarify the association between the number of medical facilities within a 15-minute driving distance from the place of residence and influenza vaccination status, using a large nationwide internet survey in Japan (n = 27,440). Postal codes were used to determine participants' place of residence and the number of medical facilities within a 15-minute drive was calculated using geographic information system data. Participants were classified into quartiles based on the number of medical facilities nearby. They reported their influenza vaccination status over the past year. Modified Poisson regression analysis was conducted with influenza vaccination status as the dependent variable and the number of medical facilities nearby as the independent variable, adjusted for covariates stratified by age (under 65 years: or 65 years and older). Among participants aged 65 years and older, those with fewer medical facilities within a 15-minute drive of their place of residence were significantly less likely to have received an influenza vaccination than those with more medical facilities nearby (prevalence ratio in Q1 relative to Q4: 0.93, 95% confidence interval 0.87-0.99). In contrast, no association was observed among participants aged under 65 years. Geographical accessibility to vaccination services may influence vaccine hesitancy among older adults in Japan, a developed country.
Keywords: 3Cs model; Influenza vaccine; developed country; geographical accessibility; older adults; travel time.