456. Pneumococcal Vaccination Coverage in Adults with High-Risk Conditions in the United States
Session: Poster Abstract Session: Pneumococcal Vaccine in Children and Adults
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: The U.S. Advisory Committee on Immunization Practices (ACIP) recommends pneumococcal vaccination for adults younger than 65 with high-risk conditions (HRCs). Yet there are limited real-world data on pneumococcal vaccination coverage (PVC) in these high-risk adults. This study aims to examine PVC and factors associated with PVC in a large US managed care population with HRCs that are included in the ACIP recommendation.

Methods: In this retrospective observational cohort study, adults aged 19-64 years with newly diagnosed HRCs from 2007 to 2010 and with continuous enrollment for at least 3 years in a large administrative claims database were identified and followed until the end of enrollment or 2011. Outcomes of interest included PVC and time to pneumococcal vaccination from the initial diagnosis. Descriptive and regression analyses were applied to assess PVC, compare patient characteristics across pneumococcal vaccination status, and examine factors associated with PVC. 

Results: The overall PVC was 7.0% among 1,105,328 adults with HRCs. PVC was highest in patients with HIV/AIDS (30.5%), followed by diabetes (11.0%), asplenia (7.9%), chronic lung disease (7.7%), chronic renal disease (7.1%), chronic heart disease (6.2%), organ transplant (5.0%), cochlear implant (4.5%), cancer (4.5%), chronic liver disease (4.3%), smoking (4.2%), and alcoholism (2.3%). Patients with HRCs aged 50-64 years had higher PVC (8.8%) than those aged 19-49 years (4.4%). Among those who received pneumococcal vaccination, the majority was vaccinated in the physician’s office (92%); the average time to vaccination was 486 days, ranging from 225 days for patients with HIV/AIDS to 607 days for patients with alcoholism. Multivariable logistic regression analysis showed that HRCs, older age, male, west region, enrollment in an HMO health plan, increased healthcare encounters, and influenza vaccination were significant predictors of receiving pneumococcal vaccination (all p<0.001).

Conclusion: While PVC varies by HRCs and sociodemographic characteristics, overall PVC remains low in adults with HRCs. Findings underscore the need for better interventions to improve pneumococcal vaccination in this high-risk adult population.

H. Keri Yang, PhD, MPH, MS1, Ming-Yi Huang, PhD1 and Dongmu Zhang, PhD2, (1)Global Health Outcomes, Merck & Co., Inc, West Point, PA, (2)Merck & co Inc; Global Health Outcomes, Whitehouse station, NJ


H. K. Yang, Merck: Employee, Salary

M. Y. Huang, Merck & Co., Inc: Independent Contractor, Salary

D. Zhang, Merck: Employee, Salary

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