Factors associated with influenza vaccination among middle-aged adults: Analysis of data from the 2025 Community Health Survey

Objectives: This study aimed to identify factors associated with influenza vaccination among middle-aged adults (40-64 years), based on Andersen’s expanded behavioral model. It focused on underexplored enabling (health screening, public health center use, health literacy) and mental health-related factors (subjective health status, stress perception, depressive experience). Methods: Data from 97,831 adults in the 2025 Community Health Survey were analyzed using Rao-Scott chi-square tests and complex-samples logistic regression (SAS 9.4). Variables were classified into predisposing, enabling, need, and health behavior factors. Results: The weighted vaccination rate was 40.4% (95% CI: 40.0-40.8%). Women (OR=1.19), adults aged 60-64 years (OR=1.42), and rural residents (OR=1.08) showed higher odds, while those aged 50-59 years or with higher education showed lower odds. Health screening showed the strongest association (OR=2.16), followed by public health center use and health literacy. Hypertension, diabetes, and osteoporosis were associated with higher odds, and depressive experience with lower odds (OR=0.90). Smoking and drinking showed lower odds, and healthy behaviors higher odds. Conclusion: Sociodemographic characteristics, healthcare utilization, chronic disease, mental health, and health behaviors were associated with vaccination. Strategies include linking health screening with vaccination outreach, targeting adults in their 50s, and connecting smokers, drinkers, and those with depressive experience to health management services.