In France, influenza vaccination (IV) coverage among individuals aged 65 and over remains below public health targets. Clarifying the structural factors influencing IV can help inform prevention campaigns.

This study uses aggregated departmental-level public data. Variations in IV coverage among individuals aged 65 years and older between 2016 and 2022 were estimated using multiple linear regression models. Changes in median income, poverty rate, health and physical activity indicators, and general practitioner availability across territories were included as explanatory variables. Individual and time fixed effects were incorporated to control for unobserved heterogeneity. Heteroskedasticity-robust standard errors were computed using White's method.

A one percentage-point increase in their poverty rate was associated with a 1.06% decrease in IV coverage among individuals aged 65 and over (p<0.001). An increase of 1 per 10,000 emergency visits for influenza-like illness was associated with a 0.004% increase in IV coverage in the following season (p<0.001). One additional general practitioner consultation per person per year was associated with a 1.56% increase in IV coverage among those aged 65 and over (p<0.01). The effect of primary care accessibility declined as median income among the 65+ population increased (p<0.001) and as their health status improved (p<0.01) Conclusions: A socio-territorial approach to the determinants of IV among older adults can help inform the scale and targeting of public health policies and, to a lesser extent, clarify the mechanisms underlying IV uptake more broadly.