PIN105 - Pneumococcal vaccination Coverage In adults with high-risk Conditions: Missed Opportunities Continue

Abstract

The U.S. Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal vaccination for adults younger than 65 years with conditions at increased risk of pneumococcal disease. Yet there are limited real-world vaccination coverage data in these high-risk adults. This study aimed to examine pneumococcal vaccination coverage and factors associated with receiving pneumococcal vaccination in U.S. adults with high-risk conditions encompassed by the ACIP recommendation. This retrospective observational cohort study included commercially-insured adults aged 19-64 years with newly-diagnosed chronic medical conditions from 2007-2010. Outcomes of interest include pneumococcal vaccination coverage and time from initial diagnosis to pneumococcal vaccination. Among 300,556 U.S. adults with high-risk conditions, 30% had their condition diagnosed by primary care physicians. On average, these adults visited pharmacy, doctor’s office, outpatient hospital, inpatient hospital and emergency department 38.3, 27.3, 6.6, 0.4, and 1.4 times, respectively, during an average 2.6 years of follow-up. Nevertheless, overall pneumococcal vaccination coverage was only 6.9%. Coverage was highest in patients with HIV (32.1%), followed by diabetes (11.2%), chronic lung disease (8.5%), asplenia (6.8%), chronic renal disease (5.9%), chronic heart disease (5.7%), cochlear implant (4.4%), cancer (4.2%), chronic liver disease (3.7%), alcoholism (2.5%), and transplant (2.0%). Among those who received pneumococcal vaccination, the majority was vaccinated in the physician’s office (99%); average time from initial diagnosis to vaccination was 469 days, ranging from 198 days for HIV to 576 days for chronic liver disease. Multivariable logistic regression showed that adults who were older, initially diagnosed by primary care physicians, received influenza vaccination, had more conditions or more healthcare encounters were more likely to receive pneumococcal vaccination. Pneumococcal vaccination coverage in adults with high-risk conditions was far below the Healthy People 2020 objective. Findings suggest missed opportunities continue and better interventions needed to improve pneumococcal vaccination during healthcare encounters for this vulnerable population.