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Tsai Y, Singleton JA, Razzaghi H. Influenza Vaccination Coverage Among Medicare Fee-for-Service Beneficiaries. Am J Prev Med 2022; 63:790-799. [PMID: 35906141 DOI: 10.1016/j.amepre.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Influenza vaccination is the best prevention strategy to protect against influenza infection. Determining accurate influenza vaccination coverage is critical. This study assesses the concordance between self-reported and claimed-based influenza vaccination coverage and examines vaccination disparities in the U.S. METHODS Data from the 2016-2019 Medicare Current Beneficiary Survey linked to survey participants' influenza vaccination claims were analyzed in 2022. The study population included survey participants aged ≥65 years and enrolled in a Medicare fee-for-service plan. Sensitivity, specificity, kappa statistics, and net bias (the difference between the estimated vaccination coverage based on survey and claims data) were reported. Associations between receipt of influenza vaccine and beneficiaries' characteristics and sex, racial and ethnic, and urban‒rural disparities in influenza vaccination were examined using logistic regressions. RESULTS The analysis included 20,854 beneficiaries. Claimed-based vaccination coverage was 60.0%, and survey-based coverage was 76.3%. The net bias was 16.3 percentage points, and kappa statistic indicated moderate data agreement. The sensitivity of self-reported influenza vaccination was 98.7%, and the specificity was 57.4%. Net bias was high among male, non-Hispanic Black and Hispanic beneficiaries, and rural residents. Sex, racial and ethnic, and urban‒rural disparities in influenza vaccination were noticeably smaller according to the survey than claims data. CONCLUSIONS The level of data agreement differed by beneficiaries' characteristics and was low among males, racial and ethnic minority groups, and rural residents.
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Affiliation(s)
- Yuping Tsai
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - James A Singleton
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hilda Razzaghi
- National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention, Atlanta, Georgia
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2
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Granade CJ, Lindley MC, Jatlaoui T, Asif AF, Jones-Jack N. Racial and Ethnic Disparities in Adult Vaccination: A Review of the State of Evidence. Health Equity 2022; 6:206-223. [PMID: 35402775 PMCID: PMC8985539 DOI: 10.1089/heq.2021.0177] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Adult vaccination coverage remains low in the United States, particularly among racial and ethnic minority populations. Objective To conduct a comprehensive literature review of research studies assessing racial and ethnic disparities in adult vaccination. Search Methods We conducted a search of PubMed, Cochrane Library, ClinicalTrials.gov, and reference lists of relevant articles. Selection Criteria Research studies were eligible for inclusion if they met the following criteria: (1) study based in the United States, (2) evaluated receipt of routine immunizations in adult populations, (3) used within-study comparison of race/ethnic groups, and (4) eligible for at least one author-defined PICO (patient, intervention, comparison, and outcome) question. Data Collection and Analysis Preliminary abstract review was conducted by two authors. Following complete abstraction of articles using a standardized template, abstraction notes and determinations were reviewed by all authors; disagreements regarding article inclusion/exclusion were resolved by majority rule. The Social Ecological Model framework was used to complete a narrative review of observational studies to summarize factors associated with disparities; a systematic review was used to evaluate eligible intervention studies. Results Ninety-five studies were included in the final analysis and summarized qualitatively within two main topic areas: (1) factors associated with documented racial-ethnic disparities in adult vaccination and (2) interventions aimed to reduce disparities or to improve vaccination coverage among racial-ethnic minority groups. Of the 12 included intervention studies, only 3 studies provided direct evidence and were of Level II, fair quality; the remaining 9 studies met the criteria for indirect evidence (Level I or II, fair or poor quality). Conclusions A considerable amount of observational research evaluating factors associated with racial and ethnic disparities in adult vaccination is available. However, intervention studies aimed at reducing these disparities are limited, are of poor quality, and insufficiently address known reasons for low vaccination uptake among racial and ethnic minority adults.
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Affiliation(s)
- Charleigh J. Granade
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan C. Lindley
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tara Jatlaoui
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amimah F. Asif
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, U.S. Department of Energy, Atlanta, Georgia, USA
| | - Nkenge Jones-Jack
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Brüne M, Emmel C, Meilands G, Andrich S, Droste S, Claessen H, Jülich F, Icks A. Self-reported medication intake vs information from other data sources such as pharmacy records or medical records: Identification and description of existing publications, and comparison of agreement results for publications focusing on patients with cancer - a systematic review. Pharmacoepidemiol Drug Saf 2021; 30:531-560. [PMID: 33617072 DOI: 10.1002/pds.5210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/18/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To identify and describe publications addressing the agreement between self-reported medication and other data sources among adults and, in a subgroup of studies dealing with cancer patients, seek to identify parameters which are associated with agreement. METHODS A systematic review including a systematic search within five biomedical databases up to February 28, 2019 was conducted as per the PRISMA Statement. Studies and agreement results were described. For a subgroup of studies dealing with cancer, we searched for associations between agreement and patients' characteristics, study design, comparison data source, and self-report modality. RESULTS The literature search retrieved 3392 publications. Included articles (n = 120) show heterogeneous agreement. Eighteen publications focused on cancer populations, with relatively good agreement identified in those which analyzed hormone therapy, estrogen, and chemotherapy (n = 11). Agreement was especially good for chemotherapy (proportion correct ≥93.6%, kappa ≥0.88). No distinct associations between agreement and age, education or marital status were identified in the results. There was little evaluation of associations between agreement and study design, self-report modality and comparison data source, thus not allowing for any conclusions to be drawn. CONCLUSION An overview of the evidence available from validation studies with a description of several characteristics is provided. Studies with experimental design which evaluate factors that might affect agreement between self-report and other data sources are lacking.
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Affiliation(s)
- Manuela Brüne
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Carina Emmel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gisela Meilands
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Sigrid Droste
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Fabian Jülich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, Young AC, Manly JJ, Heinemann AW, Magasi S, Heaton RK. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc 2017; 23:640-652. [PMID: 28660849 PMCID: PMC5703208 DOI: 10.1017/s1355617717000480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).
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Affiliation(s)
- Neco X Johnson
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Maria J Marquine
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Ilse Flores
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Anya Umlauf
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Carolyn M Baum
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alex W K Wong
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alexis C Young
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | | | - Allen W Heinemann
- 5Northwestern University,Feinberg School of Medicine,Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago,Chicago,Illinois
| | - Susan Magasi
- 6University of Illinois at Chicago,Department of Occupational Therapy,Chicago,Illinois
| | - Robert K Heaton
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
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5
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Improving adult immunization equity: Where do the published research literature and existing resources lead? Vaccine 2017; 35:3020-3025. [DOI: 10.1016/j.vaccine.2017.02.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/19/2017] [Accepted: 02/08/2017] [Indexed: 11/20/2022]
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Abstract
INTRODUCTION The Kaiser Permanente Northern California (KPNC) Member Health Survey (MHS) is used to describe sociodemographic and health-related characteristics of the adult membership of this large, integrated health care delivery system to monitor trends over time, identify health disparities, and conduct research. OBJECTIVE To provide an overview of the KPNC MHS and share findings that illustrate how survey statistics and data have been and can be used for research and programmatic purposes. METHODS The MHS is a large-scale, institutional review board-approved survey of English-speaking KPNC adult members. The confidential survey has been conducted by mail triennially starting in 1993 with independent age-sex and geographically stratified random samples, with an option for online completion starting in 2005. The full survey sample and survey data are linkable at the individual level to Health Plan and geocoded data. Respondents are assigned weighting factors for their survey year and additional weighting factors for analysis of pooled survey data. RESULTS Statistics from the 1999, 2002, 2005, 2008, and 2011 surveys show trends in sociodemographic and health-related characteristics and access to the Internet and e-mail for the adult membership aged 25 to 79 years and for 6 age-sex subgroups. Pooled data from the 2008 and 2011 surveys show many significant differences in these characteristics across the 5 largest race/ethnic groups in KPNC (non-Hispanic whites, blacks, Latinos, Filipinos, and Chinese). CONCLUSION The KPNC MHS has yielded unique insights and provides an opportunity for researchers and public health organizations outside of KPNC to leverage our survey-generated statistics and collaborate on epidemiologic and health services research studies.
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Affiliation(s)
- Nancy Gordon
- Research Scientist II at the Division of Research in Oakland, CA.
| | - Teresa Lin
- Data Consultant at the Division of Research in Oakland, CA.
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7
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Denniston MM, Monina Klevens R, Jiles RB, Murphy TV. Self-reported hepatitis A vaccination as a predictor of hepatitis A virus antibody protection in U.S. adults: National Health and Nutrition Examination Survey 2007-2012. Vaccine 2015; 33:3887-93. [PMID: 26116252 PMCID: PMC4568740 DOI: 10.1016/j.vaccine.2015.06.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To estimate the predictive value of self-reported hepatitis A vaccine (HepA) receipt for the presence of hepatitis A virus (HAV) antibody (anti-HAV) from either past infection or vaccination, as an indicator of HAV protection. METHODS Using 2007-2012 National Health and Nutrition Examination Survey data, we assigned participants to 4 groups based on self-reported HepA receipt and anti-HAV results. We compared characteristics across groups and calculated three measures of agreement between self-report and serologic status (anti-HAV): percentage concordance, and positive (PPV) and negative (NPV) predictive values. Using logistic regression we investigated factors associated with agreement between self-reported vaccination status and serological results. RESULTS Demographic and other characteristics varied significantly across the 4 groups. Overall agreement between self-reported HepA receipt and serological results was 63.6% (95% confidence interval [CI] 61.9-65.2); PPV and NPV of self-reported vaccination status for serological result were 47.0% (95% CI 44.2-49.8) and 69.4% (95% CI 67.0-71.8), respectively. Mexican American and foreign-born adults had the highest PPVs (71.5% [95% CI 65.9-76.5], and 75.8% [95% CI 71.4-79.7]) and the lowest NPVs (21.8% [95% CI 18.5-25.4], and 20.0% [95% CI 17.2-23.1]), respectively. Young (ages 20-29 years), US-born, and non-Hispanic White adults had the lowest PPVs (37.9% [95% CI 34.5-41.5], 39.1% [95% CI, 36.0-42.3], and 39.8% [36.1-43.7]), and the highest NPVs (76.9% [95% CI 72.2-81.0, 78.5% [95% CI 76.5-80.4)], and 80.6% [95% CI 78.2-82.8), respectively. Multivariate logistic analyses found age, race/ethnicity, education, place of birth and income to be significantly associated with agreement between self-reported vaccination status and serological results. CONCLUSIONS When assessing hepatitis A protection, self-report of not having received HepA was most likely to identify persons at risk for hepatitis A infection (no anti-HAV) among young, US-born and non-Hispanic White adults, and self-report of HepA receipt was least likely to be reliable among adults with the same characteristics.
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Affiliation(s)
- Maxine M Denniston
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - R Monina Klevens
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Ruth B Jiles
- Epidemiology and Surveillance Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Trudy V Murphy
- Vaccine Research and Policy, Office of the Director, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, United States.
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8
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Lochner KA, Wynne MA, Wheatcroft GH, Worrall CM, Kelman JA. Medicare claims versus beneficiary self-report for influenza vaccination surveillance. Am J Prev Med 2015; 48:384-91. [PMID: 25700653 DOI: 10.1016/j.amepre.2014.10.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/15/2014] [Accepted: 10/23/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although self-reported influenza vaccination status is routinely used in surveillance to estimate influenza vaccine coverage, Medicare data are becoming a promising resource for influenza surveillance to inform vaccination program management and planning. PURPOSE To evaluate the concordance between self-reported influenza vaccination and influenza vaccination claims among Medicare beneficiaries. METHODS This study compared influenza vaccination based upon Medicare claims and self-report among a sample of Medicare beneficiaries (N=9,378) from the 2011 Medicare Current Beneficiary Survey, which was the most recent year of data at the time of analysis (summer 2013). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated using self-reported data as the referent standard. Logistic regression was used to compute the marginal mean proportions for whether a Medicare influenza vaccination claim was present among beneficiaries who reported receiving the vaccination. RESULTS Influenza vaccination was higher for self-report (69.4%) than Medicare claims (48.3%). For Medicare claims, sensitivity=67.5%, specificity=96.3%, positive predictive value=97.6%, and negative predictive value=56.7%. Among beneficiaries reporting receiving an influenza vaccination, the percentage of beneficiaries with a vaccination claim was lower for beneficiaries who were aged <65 years, male, non-Hispanic black or Hispanic, and had less than a college education. CONCLUSIONS The classification of influenza vaccination status for Medicare beneficiaries can differ based upon survey and claims. To improve Medicare claims-based surveillance studies, further research is needed to determine the sources of discordance in self-reported and Medicare claims data, specifically for sensitivity and negative predictive value.
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Affiliation(s)
- Kimberly A Lochner
- Centers for Medicare & Medicaid Services, Sam Nunn Atlanta Federal Center, Atlanta, Georgia; Office of Information Products and Data Analytics, Baltimore, Maryland.
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9
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Rolnick SJ, Parker ED, Nordin JD, Hedblom BD, Wei F, Kerby T, Jackson JM, Crain AL, Euler G. Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors? Vaccine 2013. [PMID: 23806243 DOI: 10.1016/j.vaccine.2013.06.041.self-report] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Immunizations are crucial to the prevention of disease, thus, having an accurate measure of vaccination status for a population is an important guide in targeting prevention efforts. In order to comprehensively assess the validity of self-reported adult vaccination status for the eight most common adult vaccines we conducted a survey of vaccination receipt and compared it to the electronic medical record (EMR), which was used as the criterion standard, in a population of community-dwelling patients in a large healthcare system. In addition, we assessed whether validity varied by demographic factors. The vaccines included: pneumococcal (PPSV), influenza (Flu), tetanus diphtheria (Td), tetanus diphtheria pertussis (Tdap), Human Papilloma Virus (HPV), hepatitis A (HepA), hepatitis B (HepB) and herpes zoster (shingles). Telephone surveys were conducted with 11,760 individuals, ≥18, half with documented receipt of vaccination and half without. We measured sensitivity, specificity, positive and negative predictive value, net bias and over- and under-reporting of vaccination. Variation was found across vaccines, however, sensitivity and specificity did not vary substantially by either age or race/ethnicity. Sensitivity ranged between 63% for HepA to over 90% (tetanus, HPV, shingles and Flu). Hispanics were 2.7 times more likely to claim receipt of vaccination compared to whites. For PPSV and Flu those 65+ had low specificity compared to patients of younger ages while those in the youngest age group had lowest specificity for HepA and HepB. In addition to racial/ethnic differences, over-reporting was more frequent in those retired and those with household income less than $75,000. Accurate information for vaccination surveillance is important to estimate progress toward vaccination coverage goals and ensure appropriate policy decisions and allocation of resources for public health. It was clear from our findings that EMR and self-report do not always agree. Finding approaches to improve both EMR data capture and patient awareness would be beneficial.
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Affiliation(s)
- S J Rolnick
- HealthPartners Institute for Education & Research, P.O. Box 1524, Minneapolis, MN 55440-1524, USA.
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10
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Denniston MM, Byrd KK, Klevens RM, Drobeniuc J, Kamili S, Jiles RB. An assessment of the performance of self-reported vaccination status for hepatitis B, National Health and Nutrition Examination Survey 1999-2008. Am J Public Health 2013; 103:1865-73. [PMID: 23948014 DOI: 10.2105/ajph.2013.301313] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to assess the performance of self-reported vaccination with hepatitis B vaccine (HepB) compared with serological status for hepatitis B markers in the general US civilian population. METHODS Using 1999 through 2008 National Health and Nutrition Examination Survey data, we calculated 3 measures of agreement between self-reported HepB vaccination status and serological status: percent concordance, and positive (PPV) and negative predictive values (NPV) of self-report. Logistic regression was used to identify factors associated with agreement between self-report and serological status. RESULTS Overall agreement was 83% (95% CI = 82.3, 83.7), NPV of self-report was high (0.95; 95% CI = 0.93, 0.95) and PPV was low (0.53; 95% CI = 0.51, 0.54). Birth year relative to the 1991 recommendation for universal infant HepB vaccination had a strong association with agreement, however, the association was positive for those who reported receiving at least 3 doses and negative for those who reported receiving no doses. CONCLUSIONS Although the low PPV in our study could be attributable in part to waning of vaccine-induced anti-HBs over time, national adult HepB vaccination coverage may be lower than previously estimated because national estimates usually depend on self-report of vaccine receipt.
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Affiliation(s)
- Maxine M Denniston
- Maxine M. Denniston, R. Monina Klevens, and Ruth B. Jiles are with the Epidemiology and Surveillance Branch, Kathy K. Byrd is with the Prevention Branch, and Jan Drobeniuc and Saleem Kamili are with the Laboratory Branch, Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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11
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Rolnick SJ, Parker ED, Nordin JD, Hedblom BD, Wei F, Kerby T, Jackson JM, Crain AL, Euler G. Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors? Vaccine 2013; 31:3928-35. [PMID: 23806243 DOI: 10.1016/j.vaccine.2013.06.041] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/10/2013] [Accepted: 06/12/2013] [Indexed: 10/26/2022]
Abstract
Immunizations are crucial to the prevention of disease, thus, having an accurate measure of vaccination status for a population is an important guide in targeting prevention efforts. In order to comprehensively assess the validity of self-reported adult vaccination status for the eight most common adult vaccines we conducted a survey of vaccination receipt and compared it to the electronic medical record (EMR), which was used as the criterion standard, in a population of community-dwelling patients in a large healthcare system. In addition, we assessed whether validity varied by demographic factors. The vaccines included: pneumococcal (PPSV), influenza (Flu), tetanus diphtheria (Td), tetanus diphtheria pertussis (Tdap), Human Papilloma Virus (HPV), hepatitis A (HepA), hepatitis B (HepB) and herpes zoster (shingles). Telephone surveys were conducted with 11,760 individuals, ≥18, half with documented receipt of vaccination and half without. We measured sensitivity, specificity, positive and negative predictive value, net bias and over- and under-reporting of vaccination. Variation was found across vaccines, however, sensitivity and specificity did not vary substantially by either age or race/ethnicity. Sensitivity ranged between 63% for HepA to over 90% (tetanus, HPV, shingles and Flu). Hispanics were 2.7 times more likely to claim receipt of vaccination compared to whites. For PPSV and Flu those 65+ had low specificity compared to patients of younger ages while those in the youngest age group had lowest specificity for HepA and HepB. In addition to racial/ethnic differences, over-reporting was more frequent in those retired and those with household income less than $75,000. Accurate information for vaccination surveillance is important to estimate progress toward vaccination coverage goals and ensure appropriate policy decisions and allocation of resources for public health. It was clear from our findings that EMR and self-report do not always agree. Finding approaches to improve both EMR data capture and patient awareness would be beneficial.
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Affiliation(s)
- S J Rolnick
- HealthPartners Institute for Education & Research, P.O. Box 1524, Minneapolis, MN 55440-1524, USA.
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12
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Grimaldi-Bensouda L, Aubrun E, Leighton P, Benichou J, Rossignol M, Abenhaim L. Agreement between patients' self-report and medical records for vaccination: the PGRx database. Pharmacoepidemiol Drug Saf 2013; 22:278-85. [PMID: 23319286 DOI: 10.1002/pds.3401] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 10/19/2012] [Accepted: 12/03/2012] [Indexed: 11/08/2022]
Abstract
PURPOSE Patients' self-reported vaccine exposure (PS) may be subject to memory errors and other biases. Physicians' prescription records and other medical records (MR) do not capture noncompliance with vaccination. This study compared PS with MR for influenza, 23-valent pneumococcal, and human papillomavirus (HPV) vaccines. METHODS The Pharmacoepidemiologic General Research Extension (PGRx) database uses a network of over 300 general practitioners across France, who systematically recruit an age- and sex-stratified sample of patients (≥ 14 years old), without reference to their diagnoses or prescriptions. Patients received a structured telephone interview, combined with an interview guide listing vaccines commonly given. Patients' self-reported vaccination in the 3 years before their recruitment was compared with medical records kept by the physician or the patient. RESULTS Concordance between PS and MR was assessed for 7613 patients for whom both sources of information were available. Agreement within 3 years before the recruitment date was substantial for influenza vaccines (prevalence and bias-adjusted kappa [PABAK] = 0.74, sensitivity PS relative to MR 81.5%) and high for 23-valent pneumococcal vaccines (PABAK = 0.98, sensitivity PS 49.6) and HPV vaccines (PABAK = 0.92, sensitivity PS 91.6). In adjusted analyses, agreement varied with sociodemographic and health-related factors, particularly for influenza and 23-valent pneumococcal vaccines. CONCLUSIONS The PGRx method for drug exposure assessment is a new tool in pharmacoepidemiology that shows substantial to high agreement between PS and MR for exposure to various vaccines. Our finding of high agreement between PS and MR for HPV vaccination status in young women is a significant addition to the literature.
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Validation of self-reported folic acid use in a multiethnic population: results of the Amsterdam Born Children and their Development study. Public Health Nutr 2011; 14:2022-8. [PMID: 21324228 DOI: 10.1017/s1368980011000012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess folic acid supplementation rates and validate the self-reporting of folic acid supplement use among pregnant women in a multiethnic cohort. DESIGN Secondary analysis of a prospective cohort study. SETTING Self-reported folic acid supplement use in the Amsterdam Born Children and their Development study cohort was compared with serum folate concentrations using non-parametric trend analysis and linear and logistic regression. SUBJECTS A total of 4234 pregnant women of various ethnic backgrounds. RESULTS Serum folate levels showed a significant positive linear trend as reported use of folic acid increased (P < 0·001), which was supported by linear regression (r = 0·49). Odds of having low serum folate concentration decreased with reported early start of folic acid intake. Young, multiparous or non-Western women reported less pre-conception folic acid intake. Non-Western women showed lower serum folate concentrations. The overall rate of over-reporting, i.e. serum folate concentrations ≤20 nmol/l while reporting the use of folic acid supplements, was 20·7 %. Women of Surinamese and Moroccan ancestry had higher odds of over-reporting (OR = 2·3; 95 % CI 1·5, 3·5 and OR = 2·3; 95 % CI 1·3, 4·0, respectively). The odds for Surinamese women remained significant after adjusting for the onset of supplement use, parity and age (OR = 1·7; 95 % CI 1·1, 2·6). CONCLUSIONS Although self-reporting is a valid method for assessing folic acid supplement use in a multiethnic population, some participants do over-report. Surinamese and possibly Moroccan women appear to over-report more often. Rates of supplementation are low, especially in non-Western women. This suggests the need for intensifying current campaigns or perhaps even additional advice to start or continue to use folic acid post-conceptionally.
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Sy LS, Liu ILA, Solano Z, Cheetham TC, Lugg MM, Greene SK, Weintraub ES, Jacobsen SJ. Accuracy of influenza vaccination status in a computer-based immunization tracking system of a managed care organization. Vaccine 2010; 28:5254-9. [PMID: 20554065 DOI: 10.1016/j.vaccine.2010.05.061] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 05/06/2010] [Accepted: 05/26/2010] [Indexed: 12/01/2022]
Abstract
Influenza vaccine safety and effectiveness studies conducted using electronic medical records rely on accurate assessment of influenza vaccination status. However, influenza immunization in non-traditional settings (e.g., the workplace) may not be captured in patient immunization tracking systems. We compared influenza vaccination status from electronic records with self-reported vaccination status for five hundred and two 50-79 years olds enrolled in a large managed care organization. Influenza vaccination status in the medical record had a high positive predictive value and specificity (both >99%). The negative predictive value was 80% and sensitivity was 78%. These data suggest that an electronic record of influenza vaccination reliably indicates immunization, while the absence of such a record is only moderately accurate, partly due to vaccines received in non-traditional settings.
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Affiliation(s)
- Lina S Sy
- Kaiser Permanente Southern California, 100 South Los Robles Ave., Pasadena, CA 91101, USA.
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