Adult Influenza and Pneumonia Immunization Rates
Adult Influenza and Pneumonia Immunization Rates
Objectives: To determine national adult immunization rates for influenza and pneumonia and assess the effect of various predisposing factors on immunization status for both diseases.
Design: Retrospective, cross-sectional, random national sample data from the Centers for Disease Control and Prevention's 1999 Behavioral Risk Factor Surveillance System survey. Data extraction and analysis were conducted using SPSS and STATA, with adjustments made for weighted data.
Participants: Individuals aged 65 years and older and individuals aged 50 to 64 years (for influenza only).
Results: Immunization rates in the 65 and older age group were 66.7% for influenza and 53.8% for pneumonia; immunization rate for influenza in the 50 to 64 age group was 35.6%. Predisposing factors such as race (white) and education (high school and above) positively influenced immunization status. Enabling factors such as income, health insurance, and physician visits and need-related factors such as health status and comorbidities exhibited a strong relationship with influenza and pneumonia vaccination status in both study populations. Health care coverage (odds ratio [OR] = 1.76 for influenza and OR = 1.66 for pneumonia in the 65 years and older group; OR = 1.80 for influenza in the 50 to 64 years age group) and physician visit in the last year (OR = 2.00 for influenza and OR = 1.87 for pneumonia for 65 years and older group; OR = 1.86 for influenza in the 50 to 64 years age group) were strong positive predictors of vaccination status. Individuals with comorbidities and those who perceived their health as being poor had high vaccination rates.
Conclusion: Understanding the positive and negative influences on adult immunization status will allow pharmacists to better identify and target prospective recipients of immunization services.
Each year, influenza and pneumonia account for 50,000 to 80,000 deaths and about 400,000 hospitalizations in the United States. The total economic cost of treating these vaccine-preventable diseases among adults exceeds $10 billion each year, excluding the value of years of life lost. Immunizations are, therefore, an essential component of preventive health care. Vaccination can prevent about 50% of deaths from pneumococcal disease and 80% of deaths from influenza-related complications in the elderly. Although pharmacoeconomic studies have demonstrated the value of influenza and pneumococcal vaccines, immunization rates for these diseases continue to be low in the populations of interest.
The federal government, through Healthy People 2010, has set an influenza and pneumonia vaccination goal of at least 90% for adults aged 65 years and older. This significantly exceeds the Healthy People 2000 goal of at least 60% influenza and pneumonia vaccination rates for this group. Only the influenza vaccination goal was achieved in 1997 and then maintained in 1999.
Approximately 41 million people in the United States are in the 50- to 64-year-old age group. Of these, about 10 million to 13 million have more than one condition, such as asthma, diabetes mellitus, or heart disease, that puts them at high risk for contracting influenza. Of those who do not have a high-risk condition, many are caregivers for those who do. While this population is at high risk for complications from influenza, their immunization rates for influenza (and for pneumonia) are very low. Therefore, beginning with the 2000-2001 influenza season, the Advisory Committee on Immunization Practices (ACIP) lowered the universal age at which influenza vaccine is recommended from 65 to 50 years of age.
Several factors contribute to low adult immunization rates, including general public apathy, concerns and misconceptions about the safety and efficacy of vaccines, cost concerns, and logistic barriers, such as distance to clinics, inconvenient hours, and waiting times. One major factor determining whether an adult will be immunized is a recommendation by a health care provider. Over the years, pharmacists have increasingly participated in vaccination-related activities. Studies have shown that pharmacists can prevent both morbidity and mortality and reduce the use of health care resources by proactively advocating immunizations. Immunization rates also increased in studies that involved pharmacists as educators.
In fact, a report of the National Vaccine Advisory Committee states that nontraditional settings (e.g., pharmacies, churches) are often more accessible and convenient places to obtain immunization than are health care providers' offices or public health clinics, especially for medically underserved adults (e.g., economically disadvantaged, inner-city, and minority populations). In this context, pharmacists must understand the factors that influence vaccine-seeking behavior in adults. They should be aware of the characteristics of people who do not receive vaccinations, as well as their reasons for not getting vaccinated. Understanding these factors will help pharmacists better target their immunization promotion, advocacy, and counseling efforts to hard-to-reach populations.
In the study reported here, we used the Aday-Andersen theoretical model as the basis for our effort to identify factors associated with positive immunization status for influenza and pneumonia. The Aday-Andersen model has been widely used to demonstrate and test causal models of health care-seeking behavior and to classify determinants of health care utilization. The model focuses on understanding various characteristics of the population at risk. Health care utilization is modeled as a function of three factors:
We hypothesized that each of these variables was independently associated with the rate of use of vaccines in the target populations.
Other researchers have used the Aday-Andersen model to identify predictors of influenza and pneumonia vaccination. Petersen and colleagues studied factors associated with receipt of influenza and pneumococcal vaccines by community-dwelling adults 65 years and older residing in Iowa. Increasing age, being married, higher education, being employed, and having insurance coverage were positively related to vaccination in this population. Mark and Paramore compared influenza and pneumonia vaccination rates among elderly Hispanics relative to elderly non-Hispanics. Increasing age, higher education, and being married were among the predisposing factors positively related to vaccination status. Use of health care services was also found to increase with greater number of comorbidities and decrease in health status.
Objectives: To determine national adult immunization rates for influenza and pneumonia and assess the effect of various predisposing factors on immunization status for both diseases.
Design: Retrospective, cross-sectional, random national sample data from the Centers for Disease Control and Prevention's 1999 Behavioral Risk Factor Surveillance System survey. Data extraction and analysis were conducted using SPSS and STATA, with adjustments made for weighted data.
Participants: Individuals aged 65 years and older and individuals aged 50 to 64 years (for influenza only).
Results: Immunization rates in the 65 and older age group were 66.7% for influenza and 53.8% for pneumonia; immunization rate for influenza in the 50 to 64 age group was 35.6%. Predisposing factors such as race (white) and education (high school and above) positively influenced immunization status. Enabling factors such as income, health insurance, and physician visits and need-related factors such as health status and comorbidities exhibited a strong relationship with influenza and pneumonia vaccination status in both study populations. Health care coverage (odds ratio [OR] = 1.76 for influenza and OR = 1.66 for pneumonia in the 65 years and older group; OR = 1.80 for influenza in the 50 to 64 years age group) and physician visit in the last year (OR = 2.00 for influenza and OR = 1.87 for pneumonia for 65 years and older group; OR = 1.86 for influenza in the 50 to 64 years age group) were strong positive predictors of vaccination status. Individuals with comorbidities and those who perceived their health as being poor had high vaccination rates.
Conclusion: Understanding the positive and negative influences on adult immunization status will allow pharmacists to better identify and target prospective recipients of immunization services.
Each year, influenza and pneumonia account for 50,000 to 80,000 deaths and about 400,000 hospitalizations in the United States. The total economic cost of treating these vaccine-preventable diseases among adults exceeds $10 billion each year, excluding the value of years of life lost. Immunizations are, therefore, an essential component of preventive health care. Vaccination can prevent about 50% of deaths from pneumococcal disease and 80% of deaths from influenza-related complications in the elderly. Although pharmacoeconomic studies have demonstrated the value of influenza and pneumococcal vaccines, immunization rates for these diseases continue to be low in the populations of interest.
The federal government, through Healthy People 2010, has set an influenza and pneumonia vaccination goal of at least 90% for adults aged 65 years and older. This significantly exceeds the Healthy People 2000 goal of at least 60% influenza and pneumonia vaccination rates for this group. Only the influenza vaccination goal was achieved in 1997 and then maintained in 1999.
Approximately 41 million people in the United States are in the 50- to 64-year-old age group. Of these, about 10 million to 13 million have more than one condition, such as asthma, diabetes mellitus, or heart disease, that puts them at high risk for contracting influenza. Of those who do not have a high-risk condition, many are caregivers for those who do. While this population is at high risk for complications from influenza, their immunization rates for influenza (and for pneumonia) are very low. Therefore, beginning with the 2000-2001 influenza season, the Advisory Committee on Immunization Practices (ACIP) lowered the universal age at which influenza vaccine is recommended from 65 to 50 years of age.
Several factors contribute to low adult immunization rates, including general public apathy, concerns and misconceptions about the safety and efficacy of vaccines, cost concerns, and logistic barriers, such as distance to clinics, inconvenient hours, and waiting times. One major factor determining whether an adult will be immunized is a recommendation by a health care provider. Over the years, pharmacists have increasingly participated in vaccination-related activities. Studies have shown that pharmacists can prevent both morbidity and mortality and reduce the use of health care resources by proactively advocating immunizations. Immunization rates also increased in studies that involved pharmacists as educators.
In fact, a report of the National Vaccine Advisory Committee states that nontraditional settings (e.g., pharmacies, churches) are often more accessible and convenient places to obtain immunization than are health care providers' offices or public health clinics, especially for medically underserved adults (e.g., economically disadvantaged, inner-city, and minority populations). In this context, pharmacists must understand the factors that influence vaccine-seeking behavior in adults. They should be aware of the characteristics of people who do not receive vaccinations, as well as their reasons for not getting vaccinated. Understanding these factors will help pharmacists better target their immunization promotion, advocacy, and counseling efforts to hard-to-reach populations.
In the study reported here, we used the Aday-Andersen theoretical model as the basis for our effort to identify factors associated with positive immunization status for influenza and pneumonia. The Aday-Andersen model has been widely used to demonstrate and test causal models of health care-seeking behavior and to classify determinants of health care utilization. The model focuses on understanding various characteristics of the population at risk. Health care utilization is modeled as a function of three factors:
Predisposing factors are those that indicate the disposition of an individual or a group to use health care services, such as age, sex, or race.
Enabling factors are those that affect patients' ability to gain access to services, including income, physician visits, and health care insurance.
Need-related factors can be defined as an individual's health status as he or she perceives it and/or as evaluated by a health care provider. Need-related factors can be measured by examining the level of illness or presence of comorbidities.
We hypothesized that each of these variables was independently associated with the rate of use of vaccines in the target populations.
Other researchers have used the Aday-Andersen model to identify predictors of influenza and pneumonia vaccination. Petersen and colleagues studied factors associated with receipt of influenza and pneumococcal vaccines by community-dwelling adults 65 years and older residing in Iowa. Increasing age, being married, higher education, being employed, and having insurance coverage were positively related to vaccination in this population. Mark and Paramore compared influenza and pneumonia vaccination rates among elderly Hispanics relative to elderly non-Hispanics. Increasing age, higher education, and being married were among the predisposing factors positively related to vaccination status. Use of health care services was also found to increase with greater number of comorbidities and decrease in health status.