Pneumococcal vaccination in older adults: An initial analysis of social determinants of health and vaccine uptake
Pneumococcal vaccination in older adults: An initial analysis of social determinants of health and vaccine uptake
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DOI：
10.1016/j.vaccine.2020.06.077
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发表时间：
2020-07-31
期刊：
影响因子：
5.5
通讯作者：
Ramachandran, Sujith
中科院分区：
文献类型：
--
作者：
Gatwood, Justin;Shuvo, Sohul;Ramachandran, Sujith
目的：研究健康的社会决定因素对美国老年人肺炎球菌疫苗接种的潜在影响。方法：本研究使用了2013年至2016年的全国范围内的美国医疗保险索赔数据，以评估成年人在65岁后的第一年接受肺炎球菌疫苗接种的情况。患者从65岁开始接受随访，最初参加传统的按服务收费的医疗保险或医疗保险优势计划，并在随后的一年内观察门诊和药房的肺炎球菌疫苗接种情况。世界卫生组织的疫苗犹豫矩阵纳入并指导了关于某些健康社会决定因素的公开数据。Logistic回归确定了疫苗接种的预测因素，同时控制了临床和人口统计学特征。共有307,488和74,995名65岁的成年人分别从医疗保险优势和医疗保险服务费索赔中被确定，21.1%的Medicare Advantage和38.2%的Medicare付费服务患者在65岁后的第一年接受了肺炎球菌疫苗。居住在城市地区的人在Medicare Advantage（OR：1.31; 95% CI：1.267-1.344）和Medicare收费服务（OR：1.53; 95% CI：1.450-1.615）队列中接种肺炎球菌疫苗的可能性更高。此外，无论医疗保险类型如何，居住在健康素养较高的地区或拥有更多民主选民的社区始终与肺炎球菌疫苗接种的几率较高相关。结果还指出，接受流感疫苗，也接种肺炎球菌diseases.Conclusion：健康的社会决定因素，包括当地的健康素养，贫困，居住在更自由的地区，并获得信息之间的协同关系，可能会影响老年人的肺炎球菌疫苗相关的决定。然而，与疫苗犹豫矩阵和更细粒度的数据（例如，邮政编码水平），以充分确定在老年人中推荐的这种疫苗和其他疫苗的影响。(C)2020爱思唯尔有限公司版权所有。
Objectives: To examine the potential influence of social determinants of health on pneumococcal vaccination in older American adults.Methods: This study used nationwide, US Medicare claims data from 2013 to 2016 to assess uptake of pneumococcal vaccination among adults in the first year after turning age 65. Patients were followed from the point of being 65 years of age and initially enrolled in traditional fee-for-service Medicare or a Medicare Advantage plan through the subsequent year and observed for pneumococcal vaccination in outpatient clinics and pharmacies. Publicly-available data on select social determinants of health were incorporated and guided by the World Health Organization vaccine hesitancy matrix. Logistic regression determined predictors of vaccination while controlling clinical and demographic characteristics.Results: A total of 307,488 and 74,995 adults aged 65 years were identified from Medicare Advantage and Medicare fee-for-service claims, respectively, and 21.1% of Medicare Advantage and 38.2% of Medicare fee-for-service patients received a pneumococcal vaccine in the first year after turning 65. Those residing in urban areas had a higher likelihood of pneumococcal vaccination in both the Medicare Advantage (OR: 1.31; 95% CI: 1.267-1.344) and Medicare fee-for-service (OR: 1.53; 95% CI: 1.450-1.615) cohorts. Additionally, residing in areas of higher health literacy or communities with more democratic voters were consistently associated with a higher odds of pneumococcal vaccination regardless of Medicare type. Results also pointed to a synergistic relationship between receiving the influenza vaccine and also being vaccinated against pneumococcal disease.Conclusion: Social determinants of health, including local health literacy, poverty, residing in more liberal areas, and access to information, may be influencing the pneumococcal vaccine-related decisions of older adults. However, additional factors associated with the vaccine hesitancy matrix and more granular data (e.g., zip code-level) are needed to fully determine the impact in this and other vaccines recommended in older adults. (C) 2020 Elsevier Ltd. All rights reserved.