Vaccination Rates among the General Adult Population and High-Risk Groups in the United States

<div><h3>Background</h3><p>In order to adequately assess the effectiveness of vaccination in helping to control vaccine-preventable infectious disease, it is important to identify the adherence and uptake of risk-based recommendations.</p> <h3>Methods</h3><p>The current project includes data from five consecutive datasets of the National Health and Wellness Survey (NHWS): 2007 through 2011. The NHWS is an annual, Internet-based health questionnaire, administered to a nationwide sample of adults (aged 18 or older) which included items on vaccination history as well as high-risk group status. Vaccination rates and characteristics of vaccinees were reported descriptively. Logistic regressions were conducted to predict vaccination behavior from sociodemographics and risk-related variables.</p> <h3>Results</h3><p>The influenza vaccination rate for all adults 18 years and older has increased significantly from 28.0% to 36.2% from 2007 to 2011 (ps<.05). Compared with those not at high risk (25.1%), all high-risk groups were vaccinated at a higher rate, from 36.8% (pregnant women) to 69.7% (those with renal/kidney disease); however, considerable variability among high-risk groups was observed. Vaccination rates among high-risk groups for other vaccines varied considerably though all were below 50%, with the exception of immunocompromised respondents (57.5% for the hepatitis B vaccine and 52.5% for the pneumococcal vaccine) and the elderly (50.4% for the pneumococcal). Multiple risk factors were associated with increased rate of vaccination for most vaccines. Significant racial/ethnic differences with influenza, hepatitis, and herpes zoster vaccination rates were also observed (ps<.05).</p> <h3>Conclusions</h3><p>Rates of influenza vaccination have increased over time. Rates varied by high-risk status, demographics, and vaccine. There was a pattern of modest vaccination rate increases for individuals with multiple risk factors. However, there were relatively low rates of vaccination for most risk-based recommendations and all fell below national goals.</p> </div

Demographic profile of adults (18 years and older) who received each respective vaccine.

<p>All data is the from the 2011 NHWS dataset (N = 25,000) with the exception of the herpes zoster vaccine, which is from the 2010 NHWS dataset.</p

Vaccination rates by number of risk factors.

<p>Vaccination rates by number of risk factors.</p

National Health and Wellness Survey (NHWS) vaccination questions at each time point.

<p>N/A indicates not assessed.</p><p>As discussed above, the NHWS is conducted once per quarter for the first three quarters of each year. The item pertaining to the herpes zoster vaccine was not included in the first quarter survey in 2011 (it was included in a subsequent quarter). As a result, data on the herpes zoster vaccine was not available for this study (which only used the first quarter survey).</p

Predictors of vaccination among those at high-risk.

<p>Predictors of vaccination among those at high-risk.</p

Relationship between patient copayments in Medicare Part D and vaccination claim status for herpes zoster and tetanus-diphtheria-acellular pertussis

<p><b>Objective:</b> To assess the relationship between copay amount and vaccination claim submission status for tetanus-diphtheria-acellular pertussis (Tdap) and herpes zoster (GSK study identifier: HO-14-14319).</p> <p><b>Methods:</b> Retrospective analyses were performed using vaccination administrative claims data in patients aged ≥65 years with ≥1 claim for Tdap or zoster vaccines between 2012 and 2014. To avoid confounding by other financial responsibility, analyses were conducted among patients in the copayment phase of insurance. The impact of patient copay amount on vaccination claim status (“canceled” vs. “paid”) was evaluated by logistic regression separately for Tdap and zoster, adjusting for patient and provider characteristics.</p> <p><b>Results:</b> A total of 81,027 (39.2% with canceled claims) and 346,417 patients (56.8% with canceled claims) were included in the Tdap and zoster analyses, respectively. Mean (standard deviation) copay for canceled vs. paid claims was $37.2 (18.4) vs.$31.1 (20.1) for Tdap and $64.9 (36.9) vs.$53.5 (38.8) for zoster. The adjusted odds ratios (ORs) for a canceled Tdap vaccine claim, compared with $0 copay, were 1.19 ($1–25 copay), 1.76 ($26–50 copay), 2.42 ($51–75 copay) and 2.40 ($76–100 copay), all <i>p</i> < .001. The adjusted ORs for a canceled zoster vaccine claim, compared with$0 copay, were 1.02 ($1–25), 1.39 ($26–50), 1.66 ($51–75), 2.07 ($76–100) and 2.71 (>$100), all <i>p</i> < .001 except for$1–25 (<i>p</i> = .172).</p> <p><b>Conclusions:</b> High patient copay is a barrier to Tdap and zoster vaccinations in Medicare Part D patients. Providing vaccines at low or no copay may improve vaccination rates in these adults.</p> <p><b>GSK study identifier:</b> HO-14-14319.</p

Pregnancy Outcomes after Treatment for Cervical Cancer Precursor Lesions: An Observational Study

<div><p>Objective</p><p>To examine whether surgical procedures involving the uterine cervix were associated with pregnancy outcomes, including preterm birth, low birth weight, cesarean delivery and pregnancy loss.</p><p>Design</p><p>Population-based observational study nested in retrospective matched cohort</p><p>Setting</p><p>Kaiser Permanente Northwest integrated health plan in Oregon/Washington, U.S.A.</p><p>Population</p><p>Female health plan members age 14–53 years with documented pregnancies from 1998–2009. Women with prior excisional and ablative cervical surgical procedures (N = 322) were compared to women unexposed to cervical procedures (N = 4,307) and, separately, to those having undergone only diagnostic/biopsy procedures (N = 847).</p><p>Methods</p><p>Using log-linear regression models, we examined risk of adverse pregnancy outcomes in relation to prior excisional or ablative cervical surgical procedures. We stratified excisional procedures by excision thickness. We evaluated for confounding by age, body mass index, race, smoking history, previous preterm birth, and parity.</p><p>Results</p><p>We found a positive association between excisional treatment > = 1.0 cm and the outcomes preterm birth and low birth weight (preterm birth unadjusted risk ratio [RR] = 2.15, 95% confidence interval [CI] 1.16–3.98 for excisions ≥1.0 cm compared to unexposed women), particularly in women who delivered within one year of surgery (RR = 3.26, 95% CI 1.41–7.53). There was no clear association between excisional treatment and cesarean delivery, and treated women did not have a substantially higher risk of dysfunctional labor. Ablative treatment was not associated with low birth weight, preterm birth, or cesarean delivery but was associated with pregnancy loss (RR = 1.43, 95% CI 1.05–1.93 vs. unexposed women). Analyses using the diagnostic procedures comparison group produced similar results.</p><p>Conclusion</p><p>Women with > = 1.0 cm excisional treatment had elevated risk of preterm birth and low birth weight when compared to unexposed women and women with cervical diagnostic procedures. This suggests that increased risk derives from the treatment itself, not from other characteristics. The observed association between pregnancy loss and ablative surgical treatment requires further investigation.</p></div

Risk of preterm birth, low birth weight, and cesarean delivery in 322 women with cervical surgical treatment compared to 847 women with cervical diagnostic/biopsy procedures only, Kaiser Permanente Northwest, 1998–2009.

<p>Risk of preterm birth, low birth weight, and cesarean delivery in 322 women with cervical surgical treatment compared to 847 women with cervical diagnostic/biopsy procedures only, Kaiser Permanente Northwest, 1998–2009.</p

Time to Pregnancy among Women Exposed or Unexposed to Cervical Treatment Procedures over 12 Years of Follow-Up.

<p>Time to Pregnancy among Women Exposed or Unexposed to Cervical Treatment Procedures over 12 Years of Follow-Up.</p

Pregnancy among Women Exposed or Unexposed to Cervical Treatment orDiagnostic Procedures.

<p>HR = hazard ratio;</p><p>CI = confidence interval</p><p>^a adjusted for all covariates listed</p><p>Pregnancy among Women Exposed or Unexposed to Cervical Treatment orDiagnostic Procedures.</p