Despite these compelling data, influenza vaccination rate among at-risk adults, particularly among the middle-aged working population, remains low and unsatisfactory in many regions. In the study by Parekh et al.,5) the annual age-adjusted influenza vaccination rate among adults with cardiovascular disease in the United States increased from 38.6% (2011) to 44.3% (2020). However, individuals aged 45–64 years and those ≥65 years had 1.5- and 2.5-fold higher odds, respectively, of receiving influenza vaccination compared with those aged 18–44 years. Szőllősi et al.6) reported a decline in influenza vaccination rates in patients with cardiovascular disease in Hungary from 24% to 21% between 2009 to 2019. The influenza vaccination rates among adults younger than 65 years with chronic diseases, including cardiovascular disease, were 38.7% in France, 32.0% in Norway, and 40.4% in the Netherlands during the 2020–2021 season.7) The proportion of vaccinated patients with cardiovascular diseases is significantly lower than the recommended vaccination rate of 75% set by the European Union,8) especially among the non-elderly group. This discrepancy emphasizes the importance of age-targeted promotion strategies for influenza vaccination.

A previous study9) published the trends and factors associated with influenza vaccination among patients with cardiovascular disease from 2007 to 2019 using the data from the Korea National Health and Nutritional Examination Survey (KNHANES). The study found that influenza vaccination rate among patients with cardiovascular disease reached 74% in the 2018/2019 season; however, the rate among adults aged <65 years was only 47.3%. Furthermore, age younger than 65 years, male sex, current smoking, and a college degree were associated with lower influenza vaccination rate. By contrast, the presence of comorbidities, such as hypertension, emerged as a factor that encouraged vaccination in patients with cardiovascular disease.

A recent Korean nationwide study by Kim et al.10) investigated vaccination trends and associated factors among middle-aged working adults with elevated ASCVD risk (defined as 10-year risk ≥7.5%), also using KNHANES data. The vaccination rate in the elevated ASCVD risk group was 33.8%, higher than the 25.3% observed in their low-risk ASCVD risk group. In 2021, overall influenza vaccination rates exceeded 40% in all participants. During the COVID-19 pandemic, the Korea Disease Control and Prevention Agency expanded free influenza vaccination under the national public health policy to individuals aged ≥62 years, leading to a rapid increase in vaccination rates from 2020 to 2021. Younger individuals, males, current smokers, urban residents, and those with higher educational attainment were more likely to remain unvaccinated, suggesting that socioeconomic and behavioral factors significantly influence preventive health decisions. Interestingly, unlike the findings in patients with ASCVD,9) the presence of concomitant disease—particularly hypertension—was also associated with unvaccinated status in this specific cohort. Further research is needed to investigate how COVID-19 pandemic-related policies have influenced long-term influenza vaccination trends.

The influenza vaccination rate persists at a low level worldwide among middle-aged working adults with cardiovascular disease, despite its cardioprotective effects. The present study by Kim et al.10) further demonstrates that the influenza vaccination for individuals with elevated ASCVD risk in Korean clinical practice remains at approximately 30%. They identified urban residency and higher educational attainment as factors associated with unvaccinated status, an interesting finding that challenges prevailing social perception. Physicians and public health initiatives should focus on increasing public awareness and promoting influenza vaccination among these populations. These results provide an important basis for expanding the national influenza vaccination program in Korea to include individuals younger than 65 years with cardiovascular disease or elevated ASCVD risk. In addition, further research is needed to investigate how national public health policies related to the COVID-19 pandemic have influenced long-term trends in influenza vaccination, particularly among high-risk populations.