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Background: Persons with chronic conditions are at increased risk for morbidity and mortality during influenza epidemics. However, influenza vaccination levels in this population are below national Healthy People 2010 objectives of 60%.
Objectives: Determine prevalence of missed influenza vaccination opportunities and correlates, and examine opinions/attitudes and reasons for non-vaccination among adults with chronic conditions recommended for vaccination by the Advisory Committee for Immunization Practices during 2009-10 influenza season.
Methods: We determined prevalence of missed vaccination opportunities (i.e. ≥1 health-care visit since August 2009, no health-care-personnel (HCP) recommendation for vaccination and no influenza vaccination) among 3,361 adults (18-64 years) with chronic conditions responding to the National 2009 H1N1 Flu Survey (March-May 2010). We used chi-square to compare socio-demographic characteristics, opinions/attitudes and reasons for non-vaccination by receipt of HCP recommendation among participants with ≥1 health-care visit. We examined associations between missed opportunities and selected socio-demographic characteristics using logistic regression models and predicted marginals.
Results: Influenza vaccination coverage differed significantly by age, race/ethnicity, years of education and medical insurance status. HCP recommendation recipients were statistically more likely than non-recipients to get vaccinated. “Concern about side effects” and “vaccination not needed” were the most common reasons for non-vaccination among recommendation recipients and non-recipients, respectively. In multivariable analysis: the following characteristics were statistically associated with missed opportunities: male gender [adjusted prevalence ratio (APR) 1.25 95% CI (1.10-1.42), age 18-49 years [APR 1.53 (1.31-1.78)], non-Hispanic black race/ethnicity [APR 1.24 (1.03-1.49)], and ‹12 years of education [APR 1.35 (1.09-1.68)]. Persons with medical insurance [APR 0.63 (0.54-0.74)] were statistically less likely to have missed opportunities.
Conclusions: Socio-demographic differences in missed opportunities exist among adults with chronic conditions. Since HCP recommendations for influenza vaccination are positively associated with the opinions/attitudes and vaccination status of patients with chronic conditions, promotion of HCP recommendations needs to be emphasized by immunization programs.