Uptake of Influenza Vaccination and Missed Opportunities Among Adults with High-Risk Conditions, United States, 2013.
Uptake of Influenza Vaccination and Missed Opportunities Among Adults with High-Risk Conditions, United States, 2013.
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DOI：
10.1016/j.amjmed.2015.10.031
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发表时间：
2016-06
期刊：
影响因子：
--
通讯作者：
Williams WW
中科院分区：
文献类型：
--
作者：
Lu PJ;O'Halloran A;Ding H;Srivastav A;Williams WW
自1960年以来，免疫实践咨询委员会（ACIP）一直建议为某些高危人群接种流感疫苗，因为流感感染并发症的风险增加。我们评估了18-64岁高危人群的全国流感疫苗接种情况。我们分析了2012年和2013年国民健康访谈调查（NHIS）的数据。Kaplan-Meier生存分析程序用于估计18-64岁高危成人中流感疫苗接种的累积比例。还评估了潜在的流感疫苗接种机会。进行多变量逻辑回归和预测边际分析，以确定与疫苗接种独立相关的因素。总体而言，3990万18-64岁的成年人（18.9%）至少有一种高风险状况。对于18-64岁的高危人群，流感疫苗接种覆盖率为49.5%。50-64岁成年人的覆盖率明显高于18-49岁成年人（59.3%对39.0%; p<0.05）。在18-64岁的成年人中，慢性肺病患者的覆盖率为46.2%，心脏病患者为50.5%，糖尿病患者为58.0%，肾病患者为62.5%，癌症患者为56.4%。总体而言，90.1%的人报告至少有一次到本可以提供疫苗接种的卫生保健机构就诊。在18-64岁的高危人群中，年龄较大，女性，西班牙裔或亚裔，有一次或多次医生就诊，定期医生进行医疗保健，健康保险以及曾经接受过肺炎球菌疫苗接种与流感疫苗接种的可能性较高独立相关。丧偶/离婚/分居或从未结婚和没有工作与流感疫苗接种的可能性较低独立相关。流感疫苗接种覆盖率因年龄和高危状况而异，但仍然很低。大约50%的高危人群仍未接种疫苗。卫生保健提供者应确保他们定期评估流感疫苗接种状况，向高危人群推荐和提供疫苗。
Since 1960, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination for adults with certain high-risk conditions because of increased risk for complications from influenza infection. We assessed national influenza vaccination among persons 18-64 years with high-risk conditions. We analyzed data from the 2012 and 2013 National Health Interview Survey (NHIS). The Kaplan-Meier survival analysis procedure was used to estimate the cumulative proportion of influenza vaccination among adults 18-64 years with high-risk conditions. Potential missed opportunities for influenza vaccination were also evaluated. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with vaccination. Overall, 39.9 million adults 18-64 years (18.9%) had at least one high-risk condition. For adults 18-64 years with high-risk conditions, overall influenza vaccination coverage was 49.5%. Coverage among adults 50-64 years was significantly higher compared with those 18-49 years (59.3% vs. 39.0%; p<0.05). Among adults 18-64 years, coverage was 46.2% for those with chronic lung diseases, 50.5% for those with heart disease, 58.0% for those with diabetes, 62.5% for those with renal disease, and 56.4% for those with cancer. Overall, 90.1% reported at least one visit to a health care setting where vaccination could have been provided. Among adults 18-64 years with high-risk conditions, older age, being female, Hispanic ethnicity or Asian race, having one or more physician visits, a regular physician for health care, health insurance, and having ever received pneumococcal vaccination were independently associated with a higher likelihood of influenza vaccination. Being widowed/divorced/separated or never married and not being employed were independently associated with a lower likelihood of influenza vaccination Influenza vaccination coverage varies substantially by age and high-risk conditions but remains low. Approximately 50% of those with high-risk conditions remain unvaccinated. Healthcare providers should ensure they routinely assess influenza vaccination status, recommend and offer vaccines to those with high-risk conditions.
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