Dataset Information

State-Level Variations and Factors Associated with Adult Vaccination Coverage: A Multilevel Modeling Approach.

ABSTRACT:

Background

Adult vaccination rates in the USA are generally low and fall short of public health goals.

Objectives

Our aim was to evaluate the effect of state-level characteristics on adult vaccination coverage in the USA.

Methods

This study was a cross-sectional, retrospective analysis of 2015-2017 Behavioral Risk Factor Surveillance System data, conducted from March to October 2019 and including seasonal influenza; pneumococcal; tetanus, diphtheria, and acellular pertussis (Tdap); and herpes zoster (HZ) vaccines. Multilevel logistic regression models examined interstate vaccination coverage variability and assessed the impact of state-level characteristics, with model-adjusted coverage estimated.

Results

Model-adjusted vaccination coverage varied by state, with 35.1-48.1% coverage for influenza (2017), 68.2-80.8% for pneumococcal (2017), 21.9-46.5% for Tdap (2016), and 30.5-50.9% for HZ (2017). Characteristics associated with vaccination included state-level insurance coverage, pharmacists' vaccination authority, vaccination exemptions, and adult immunization information systems participation, as well as individual-level measures of income and education. After adjusting for these factors, substantial interstate heterogeneity remained.

Conclusions

Model-adjusted coverage was generally low and varied by state. A small number of state-level characteristics partially explained interstate coverage variability. This and future research assessing additional state characteristics may help determine policies most likely to increase adult vaccination.

SUBMITTER: Garbinsky D

PROVIDER: S-EPMC8333180 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:INTRODUCTION:Influenza is a major cause of morbidity and mortality among adults. The most effective strategy for preventing influenza is annual vaccination. However, vaccination coverage has been suboptimal among adult populations. The purpose of this study is to assess trends in influenza vaccination among adult populations. METHODS:Data from the 2010-2016 National Health Interview Survey were analyzed in 2018 to estimate vaccination coverage during the 2010-2011 through 2015-2016 seasons. Trends of vaccination in recent years were assessed. Vaccination coverage by race/ethnicity within each group was examined. Multivariable logistic regression and predictive marginal models were conducted to identify factors associated with vaccination, and interactions between race/ethnicity and other demographic and access-to-care characteristics were assessed. RESULTS:Vaccination coverage among adults aged ?18 years increased from 38.3% in the 2010-2011 season to 43.4% in the 2015-2016 season, with an average increase of 1.3 percentage points annually. From the 2010-2011 through 2015-2016 seasons, coverage was stable for adults aged ?65 years and changed by -0.1 to 9.9 percentage points for all other examined subgroups. Coverage in 2015-2016 was 70.4% for adults aged ?65 years, 46.4% for those aged 50-64 years, and 32.3% for those aged 18-49 years; 47.9% for people aged 18-64 years with high-risk conditions; 64.8% for healthcare personnel; and 50.3% for pregnant women. Among adults aged ?18 years for the 2015-2016 season, coverage was significantly lower among non-Hispanic blacks and Hispanics compared with non-Hispanic whites. CONCLUSIONS:Overall, influenza vaccination coverage among adults aged ?18 years increased during 2010-2016, but it remained below the national target of 70%. Vaccination coverage varied by age, risk status, race/ethnicity, healthcare personnel, and pregnancy status. Targeted efforts are needed to improve coverage and reduce disparities.