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Silva JBB, Howe CJ, Jackson JW, Riester MR, Bardenheier BH, Xu L, Puckrein G, van Aalst R, Loiacono MM, Zullo AR. Geographic Variation in Racial Disparities in Receipt of High-Dose Influenza Vaccine Among US Older Adults. J Racial Ethn Health Disparities 2024; 11:1520-1529. [PMID: 37184814 PMCID: PMC10184628 DOI: 10.1007/s40615-023-01628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/29/2023] [Accepted: 04/30/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Racial disparities in receipt of high-dose influenza vaccine (HDV) have been documented nationally, but whether small-area geographic variation in such disparities exists remains unknown. We assessed the distribution of disparities in HDV receipt between Black and White traditional Medicare beneficiaries vaccinated against influenza within states and hospital referral regions (HRRs). METHODS We conducted a nationally representative retrospective cohort study of 11,768,724 community-dwelling traditional Medicare beneficiaries vaccinated against influenza during the 2015-2016 influenza season (94.3% White and 5.7% Black). Our comparison was marginalized versus privileged racial group measured as Black versus White race. Vaccination and type of vaccine were obtained from Medicare Carrier and Outpatient files. Differences in the proportions of individuals who received HDV between Black and White beneficiaries within states and HRRs were used to measure age- and sex-standardized disparities in HDV receipt. We restricted to states and HRRs with ≥ 100 beneficiaries per age-sex strata per racial group. RESULTS We detected a national disparity in HDV receipt of 12.8 percentage points (pps). At the state level, the median standardized HDV receipt disparity was 10.7 pps (minimum, maximum: 2.9, 25.6; n = 30 states). The median standardized HDV receipt disparity among HRRs was 11.6 pps (minimum, maximum: 0.4, 24.7; n = 54 HRRs). CONCLUSION Black beneficiaries were less likely to receive HDV compared to White beneficiaries in almost every state and HRR in our analysis. The magnitudes of disparities varied substantially across states and HRRs. Local interventions and policies are needed to target geographic areas with the largest disparities to address these inequities.
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Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA.
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Epidemiologic Research, Brown University School of Public Health, Providence, RI, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Westat LLC, Rockville, MD, USA
| | - Liou Xu
- National Minority Quality Forum, Washington, DC, USA
| | - Gary Puckrein
- National Minority Quality Forum, Washington, DC, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Department of Modelling, Epidemiology, and Data Science, Sanofi, Lyon, France
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-3, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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Gadbois EA, Meehan A, Uth R, Baier RR, Gravenstein S, Zullo AR, Kabler H, Loiacono MM, Bardenheier BH. Identifying strategies that promote staff and resident influenza and COVID-19 vaccination in nursing homes: Perspectives from nursing home staff. Geriatr Nurs 2023; 54:205-210. [PMID: 37844537 DOI: 10.1016/j.gerinurse.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/18/2023]
Abstract
Resident and staff influenza and COVID-19 vaccination are critical components of infection prevention in nursing homes. Our study sought to characterize strategies that nursing home staff use to promote vaccination. Twenty-six telephone/videoconference interviews were conducted with administrators, directors of nursing, infection preventionists, and Minimum Data Set coordinators at 14 nursing homes across the US. Transcripts were analyzed using content analysis and a detailed audit trail was maintained. Staff described resident and staff influenza and COVID-19 vaccine hesitancy and confidence as well as varying approaches to promote vaccination. These included incentives, education efforts, and having a "vaccine champion" responsible for vaccine promotion. While many strategies had been in place prior to COVID-19 in support of improving influenza vaccination, participants reported implementing additional approaches to promote COVID-19 vaccination. Findings may inform future efforts to promote vaccination, which will be critical to mitigate the burden of influenza and COVID-19 in nursing homes.
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Affiliation(s)
- Emily A Gadbois
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States.
| | - Amy Meehan
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Rebecca Uth
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Rosa R Baier
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States
| | - Stefan Gravenstein
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Warren Alpert Medical School of Brown University, 222 Richmond St., Providence, RI 02903, United States; Providence Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI 02908, United States
| | - Andrew R Zullo
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Providence Veterans Affairs Medical Center, 830 Chalkstone Ave., Providence, RI 02908, United States; Department of Pharmacy, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, United States
| | - Heidi Kabler
- Medical Affairs, Sanofi, 1 Discovery Dr., Swiftwater, PA 18370, United States
| | - Matthew M Loiacono
- Global Medical Evidence Generation, Sanofi, 1 Discovery Dr., Swiftwater, PA 18370, United States
| | - Barbara H Bardenheier
- Brown University School of Public Health, 121 S. Main St., Providence, RI 02903, United States; Westat, Inc., 1600 Research Blvd., Rockville, MD 20850, United States
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3
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Silva JBB, Howe CJ, Jackson JW, Bardenheier BH, Riester MR, van Aalst R, Loiacono MM, Zullo AR. Geospatial Distribution of Racial Disparities in Influenza Vaccination in Nursing Homes. J Am Med Dir Assoc 2023:104804. [PMID: 37739348 PMCID: PMC10950839 DOI: 10.1016/j.jamda.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES This study aimed to assess the distribution of racial disparities in influenza vaccination between White and Black short-stay and long-stay nursing home residents among states and hospital referral regions (HRRs). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS We included short-stay and long-stay older adults residing in US nursing homes during influenza seasons between 2011 and 2018. Included residents were aged ≥65 years and enrolled in Traditional Medicare. Analyses were conducted using resident-seasons, whereby residents could contribute to one or more influenza seasons if they resided in a nursing home across multiple seasons. METHODS Our comparison of interest was marginalized vs privileged racial group membership measured as Black vs White race. We obtained influenza vaccination documentation from resident Minimum Data Set assessments from October 1 through June 30 of a particular influenza season. Nonparametric g-formula was used to estimate age- and sex-standardized disparities in vaccination, measured as the percentage point (pp) difference in the proportions of individuals vaccinated between Black and White nursing home residents within states and HRRs. RESULTS The study included 7,807,187 short-stay resident-seasons (89.7% White and 10.3% Black) in 14,889 nursing homes and 7,308,111 long-stay resident-seasons (86.7% White and 13.3% Black) in 14,885 nursing homes. Among states, the median age- and sex-standardized disparity between Black and White residents was 10.1 percentage points (pps) among short-stay residents and 5.3 pps among long-stay residents across seasons. Among HRRs, the median disparity was 8.6 pps among short-stay residents and 5.0 pps among long-stay residents across seasons. CONCLUSIONS AND IMPLICATIONS Our analysis revealed that the magnitudes of vaccination disparities varied substantially across states and HRRs, from no disparity in vaccination to disparities in excess of 25 pps. Local interventions and policies should be targeted to high-disparity geographic areas to increase vaccine uptake and promote health equity.
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Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center for Epidemiologic Research, Brown University School of Public Health, Providence, RI, USA
| | - John W Jackson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public health, Baltimore, MD, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Modelling, Epidemiology, and Data Science, Sanofi, Lyon, France; Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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4
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Riester MR, Roberts AI, Silva JBB, Howe CJ, Bardenheier BH, van Aalst R, Loiacono MM, Zullo AR. Geographic Variation in Influenza Vaccination Disparities Between Hispanic and Non-Hispanic White US Nursing Home Residents. Open Forum Infect Dis 2022; 9:ofac634. [PMID: 36540392 PMCID: PMC9757686 DOI: 10.1093/ofid/ofac634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/22/2022] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Disparities in influenza vaccination exist between Hispanic and non-Hispanic White US nursing home (NH) residents, but the geographic areas with the largest disparities remain unknown. We examined how these racial/ethnic disparities differ across states and hospital referral regions (HRRs). METHODS This retrospective cohort study included >14 million short-stay and long-stay US NH resident-seasons over 7 influenza seasons from October 1, 2011, to March 31, 2018, where residents could contribute to 1 or more seasons. Residents were aged ≥65 years and enrolled in Medicare fee-for-service. We used the Medicare Beneficiary Summary File to ascertain race/ethnicity and Minimum Data Set assessments for influenza vaccination. We calculated age- and sex-standardized percentage point (pp) differences in the proportions vaccinated between non-Hispanic White and Hispanic (any race) resident-seasons. Positive pp differences were considered disparities, where the proportion of non-Hispanic White residents vaccinated was greater than the proportion of Hispanic residents vaccinated. States and HRRs with ≥100 resident-seasons per age-sex stratum per racial/ethnic group were included in analyses. RESULTS Among 7 442 241 short-stay resident-seasons (94.1% non-Hispanic White, 5.9% Hispanic), the median standardized disparities in influenza vaccination were 4.3 pp (minimum, maximum: 0.3, 19.2; n = 22 states) and 2.8 pp (minimum, maximum: -3.6, 10.3; n = 49 HRRs). Among 6 758 616 long-stay resident-seasons (93.7% non-Hispanic White, 6.5% Hispanic), the median standardized differences were -0.1 pp (minimum, maximum: -4.1, 11.4; n = 18 states) and -1.8 pp (minimum, maximum: -6.5, 7.6; n = 34 HRRs). CONCLUSIONS Wide geographic variation in influenza vaccination disparities existed across US states and HRRs. Localized interventions targeted toward areas with high disparities may be a more effective strategy to promote health equity than one-size-fits-all national interventions.
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Affiliation(s)
- Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Anthony I Roberts
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Chanelle J Howe
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Epidemiologic Research, Brown University, Providence, Rhode Island, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Westat LLC, Rockville, Maryland, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Modelling, Epidemiology, and Data Science, Global Medical Affairs, Sanofi, Lyon, France
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Matthew M Loiacono
- Global Medical Evidence Generation, Sanofi, Swiftwater, Pennsylvania, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
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5
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Jutkowitz E, Mitchell LL, Bardenheier BH, Gaugler JE. Profiles of Caregiving Arrangements of Community-dwelling People Living with Probable Dementia. J Aging Soc Policy 2022; 34:860-875. [PMID: 34003081 PMCID: PMC8599523 DOI: 10.1080/08959420.2021.1927613] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
People living with dementia receive care from multiple caregivers, but little is known about the structure of their caregiving arrangements. This study used the Health and Retirement Study and latent class analyses to identify subgroups of caregiving arrangements based on caregiving hours received from spouses, children, other family/friends, and paid individuals among married (n = 361) and unmarried (n = 473) community-dwelling people with probable dementia. Three classes in the married sample (class 1 "low hours with shared care," class 2 "spouse-dominant care," and class 3 "children-dominant care") were identified. In class 1, spouses, children, and paid individuals provided 53%, 22%, and 26% of the caregiving hours, respectively. Three classes in the unmarried sample (class 1 "low hours with shared care," class 2 "children-dominant care," and class 3 "paid-dominant care") were identified. In unmarried class 1, children, other family/friends, and paid individuals provided 35%, 41% and 24% of the caregiving hours, respectively.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Box G-S121-6, 121 S. Main Street, 6th Floor, Providence, RI 02912
- Providence Veterans Affairs (VA) Medical Center, Center of Innovation in Long Term Services and Supports, Providence, RI, 02908, Phone: 401-863-2060, Fax: 401-863-3489
| | - Lauren L. Mitchell
- Center for Care Delivery & Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN 55417
| | - Barbara H. Bardenheier
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI 02912
| | - Joseph E. Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455
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6
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Meehan A, Uth R, Gadbois EA, Baier RR, Gravenstein S, Zullo AR, Kabler H, Loiacono MM, Bardenheier BH. Impact of COVID-19 on influenza and infection control practices in nursing homes. J Am Geriatr Soc 2022; 71:661-665. [PMID: 36146903 PMCID: PMC9538598 DOI: 10.1111/jgs.18061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Amy Meehan
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Rebecca Uth
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Emily A. Gadbois
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Rosa R. Baier
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Stefan Gravenstein
- Brown University School of Public HealthProvidenceRhode IslandUSA,Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA,Providence Veterans Affairs Medical CenterProvidenceRhode IslandUSA
| | - Andrew R. Zullo
- Brown University School of Public HealthProvidenceRhode IslandUSA,Providence Veterans Affairs Medical CenterProvidenceRhode IslandUSA,Rhode Island HospitalProvidenceRhode IslandUSA
| | | | | | - Barbara H. Bardenheier
- Brown University School of Public HealthProvidenceRhode IslandUSA,Westat, Inc.RockvilleMarylandUSA
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Bardenheier BH, White EM, Blackman C, Gravenstein S, Gutman R, Sarkar IN, Feifer RA, McConeghy K, Nanda A, Duprey M, Mor V. Adverse events following third dose of mRNA COVID-19 vaccination among nursing home residents who received the primary series. J Am Geriatr Soc 2022; 70:1642-1647. [PMID: 35460263 PMCID: PMC9115078 DOI: 10.1111/jgs.17812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND We sought to compare rates of adverse events among nursing home residents who received an mRNA COVID-19 vaccine booster dose with those who had not yet received their booster. METHODS We assessed a prospective cohort of 11,200 nursing home residents who received a primary COVID-19 mRNA vaccine series at least 6 months prior to September 22, 2021 and received a third "booster dose" between September 22, 2021 and February 2, 2022. Residents lived in 239 nursing homes operated by Genesis HealthCare, spanning 21 U.S. states. We screened electronic health records for 20 serious vaccine-related adverse events that are monitored following receipt of COVID-19 vaccination by the CDC's Vaccine Safety Datalink. We matched boosted and yet-to-be boosted residents during the same time period, comparing rates of events occurring 14 days after booster administration with those occurring 14 days prior to booster administration. To supplement previously reported background rates of adverse events, we report background rates of medical conditions among nursing home residents during 2020, before COVID-19 vaccines were administered in nursing homes. Events occurring in 2021-2022 were confirmed by physician chart review. We report unadjusted rates of adverse events and used a false discovery rate procedure to adjust for multiplicity of events tested. RESULTS No adverse events were reported during the 14 days post-booster. A few adverse events occurred prior to booster (ischemic stroke: 49.4 per 100,000 residents, 95% CI: 21.2, 115.7; venous thromboembolism: 9.9 per 100,000 residents, 95% CI: 1.7, 56.0), though differences in event rates pre- versus post-booster were not statistically significant (p < 0.05) after adjusting for multiple comparisons. No significant differences were detected between post-booster vaccination rates and prior year 14-day background rates of medical conditions. CONCLUSIONS No safety signals were detected following a COVID-19 mRNA vaccine booster dose in this large multi-state sample of nursing home residents.
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Affiliation(s)
- Barbara H. Bardenheier
- Health Services, Policy, and Practice DepartmentBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Elizabeth M. White
- Health Services, Policy, and Practice DepartmentBrown University School of Public HealthProvidenceRhode IslandUSA
| | | | - Stefan Gravenstein
- Health Services, Policy, and Practice DepartmentBrown University School of Public HealthProvidenceRhode IslandUSA
- Center on Innovation in Long‐Term Services and SupportsProvidence Veterans Administration Medical CenterProvidenceRhode IslandUSA
- Warren Alpert Medical School Department of MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Roee Gutman
- Health Services, Policy, and Practice DepartmentBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Indra Neil Sarkar
- Health Services, Policy, and Practice DepartmentBrown University School of Public HealthProvidenceRhode IslandUSA
- Warren Alpert Medical School Department of MedicineBrown UniversityProvidenceRhode IslandUSA
- Rhode Island Quality InstituteProvidenceRhode IslandUSA
| | | | - Kevin McConeghy
- Health Services, Policy, and Practice DepartmentBrown University School of Public HealthProvidenceRhode IslandUSA
- Center on Innovation in Long‐Term Services and SupportsProvidence Veterans Administration Medical CenterProvidenceRhode IslandUSA
| | - Aman Nanda
- Warren Alpert Medical School Department of MedicineBrown UniversityProvidenceRhode IslandUSA
| | - Matthew Duprey
- Health Services, Policy, and Practice DepartmentBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Vincent Mor
- Health Services, Policy, and Practice DepartmentBrown University School of Public HealthProvidenceRhode IslandUSA
- Center on Innovation in Long‐Term Services and SupportsProvidence Veterans Administration Medical CenterProvidenceRhode IslandUSA
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8
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Bardenheier BH, McConeghy KW, Davidson HE, Gravenstein S. US nursing home residents receiving PCV13 in the SNF by recorded pneumococcal vaccination up-to-date status, 2014-2018. J Am Geriatr Soc 2022; 70:1726-1733. [PMID: 35211964 DOI: 10.1111/jgs.17717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/21/2022] [Accepted: 01/29/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since PCV13 was recommended in 2014, the characteristics of nursing home (NH) residents (and their facilities) recorded by facilities as not up-to-date with pneumococcal vaccination upon admission were unknown, and it is unknown if they received PCV13 in the NH. METHODS We conducted a retrospective cohort of NH residents of Centers for Medicare and Medicaid (CMS)-certified skilled nursing facilities from October 1, 2014, through September 22, 2018. CMS' Minimum Data Set (MDS) was linked to Medicare Part B Carrier claims to corroborate pneumococcal vaccination up-to-date status in the MDS with pneumococcal vaccination claims. The primary outcome of interest was vaccination with PCV13 versus nonreceipt among those identified as "not up to date" according to facility MDS records. We estimated generalized estimating equation (GEE) models. RESULTS Of the 1,459,814 residents recorded not up-to-date, (78.2%) had no Part B claims for PCV13 before or in the NH, the majority of whom (71.5%) were reported to have refused the vaccine when offered. Only 1.3% subsequently received PCV13 within 99 days after NH admission. In adjusted analyses, residents less likely to receive PCV13 in the NH than those who did included: residence in a for-profit facility (OR: 0.94 [95% CI: 0.89, 0.99]); male (OR: 0.92 [95% CI:0.89, 0.95]); black race (OR: 0.71 (95%CI: 0.66, 0.77); Hispanic ethnicity (OR: 0.69 [95%CI: 0.59, 0.75]); severely cognitively impaired compared with any lesser degree of impairment; had diabetes (OR: 0.93 [95%CI: 0.89, 0.97]); long-stay (≥100 days) compared with short-stay residents (OR: 0.17 (95%CI: 0.15, 0.20); and did not receive the influenza vaccine (OR: 0.74 (95%CI: 0.71, 0.77). CONCLUSIONS Due to refusals, few NH residents recorded not up-to-date on pneumococcal vaccinations from 2014 to 2018 received PCV13 within three months of admission. Strategies to promote newly recommended PCV15 or PCV20 vaccination upon NH admission may be needed.
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Affiliation(s)
| | - Kevin W McConeghy
- School of Public Health, Brown University, Providence, Rhode Island, USA.,Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, USA
| | | | - Stefan Gravenstein
- School of Public Health, Brown University, Providence, Rhode Island, USA.,Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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9
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Moyo P, Bosco E, Bardenheier BH, Rivera-Hernandez M, van Aalst R, Chit A, Gravenstein S, Zullo AR. Variation in influenza vaccine assessment, receipt, and refusal by the concentration of Medicare Advantage enrollees in U.S. nursing homes. Vaccine 2022; 40:1031-1037. [PMID: 35033387 PMCID: PMC8917469 DOI: 10.1016/j.vaccine.2021.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 12/22/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND More older adults enrolled in Medicare Advantage (MA) are entering nursing homes (NHs), and MA concentration could affect vaccination rates through shifts in resident characteristics and/or payer-related influences on preventive services use. We investigated whether rates of influenza vaccination and refusal differ across NHs with varying concentrations of MA-enrolled residents. METHODS We analyzed 2014-2015 Medicare enrollment data and Minimum Data Set clinical assessments linked to NH-level characteristics, star ratings, and county-level MA penetration rates. The independent variable was the percentage of residents enrolled in MA at admission and categorized into three equally-sized groups. We examined three NH-level outcomes including the percentages of residents assessed and appropriately considered for influenza vaccination, received influenza vaccination, and refused influenza vaccination. RESULTS There were 936,513 long-stay residents in 12,384 NHs. Categories for the prevalence of MA enrollment in NHs were low (0% to 3.3%; n = 4131 NHs), moderate (3.4% to 18.6%; n = 4127 NHs) and high (>18.6%; n = 4126 NHs). Overall, 81.3% of long-stay residents received influenza vaccination and 14.3% refused the vaccine when offered. Adjusting for covariates, influenza vaccination rates among long-stay residents were higher in NHs with moderate (1.70 percentage points [pp], 95% confidence limits [CL]: 1.15 pp, 2.24 pp), or high (3.05 pp, 95% CL: 2.45 pp, 3.66 pp) MA versus the lowest prevalence of MA. Influenza vaccine refusal was lower in NHs with moderate (-3.10 pp, 95% CL: -3.53 pp, -2.68 pp), or high (-4.63 pp, 95% CL: -5.11 pp, -4.15 pp) MA compared with NHs with the lowest prevalence of MA. CONCLUSION A higher concentration of long-stay NH residents enrolled in MA was associated with greater influenza vaccine receipt and lower vaccine refusal. As MA becomes a larger share of the Medicare program, and more MA beneficiaries enter NHs, decisionmakers need to consider how managed care can be leveraged to improve the delivery of preventive services like influenza vaccinations in NH settings.
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Affiliation(s)
- Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA.
| | - Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA; Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA
| | - Robertus van Aalst
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Modelling, Epidemiology, and Data Science, Sanofi Pasteur, Lyon, France; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ayman Chit
- Sanofi Pasteur, Swiftwater, PA, USA; Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Health Care Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
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10
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Riester MR, Bosco E, Silva JBB, Bardenheier BH, Goyal P, O’Neil ET, van Aalst R, Chit A, Gravenstein S, Zullo AR. Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis. PLoS One 2022; 17:e0260664. [PMID: 35051181 PMCID: PMC8775208 DOI: 10.1371/journal.pone.0260664] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pneumonia and sepsis are among the most common causes of hospitalization in the United States and often result in discharges to a skilled nursing facility (SNF) for rehabilitation. We described the timing and most common causes of 30-day unplanned hospital readmission following an index hospitalization for pneumonia or sepsis. METHODS AND FINDINGS This national retrospective cohort study included adults ≥65 years who were hospitalized for pneumonia or sepsis and were discharged to a SNF between July 1, 2012 and July 4, 2015. We quantified the ten most common 30-day unplanned readmission diagnoses and estimated the daily risk of first unplanned rehospitalization for four causes of readmission (circulatory, infectious, respiratory, and genitourinary). The index hospitalization was pneumonia for 92,153 SNF stays and sepsis for 452,254 SNF stays. Of these SNF stays, 20.9% and 25.9%, respectively, resulted in a 30-day unplanned readmission. Overall, septicemia was the single most common readmission diagnosis for residents with an index hospitalization for pneumonia (16.7% of 30-day readmissions) and sepsis (22.4% of 30-day readmissions). The mean time to unplanned readmission was approximately 14 days overall. Respiratory causes displayed the highest daily risk of rehospitalization following index hospitalizations for pneumonia, while circulatory and infectious causes had the highest daily risk of rehospitalization following index hospitalizations for sepsis. The day of highest risk for readmission occurred within two weeks of the index hospitalization discharge, but the readmission risk persisted across the 30-day follow-up. CONCLUSION Among older adults discharged to SNFs following a hospitalization for pneumonia or sepsis, hospital readmissions for infectious, circulatory, respiratory, and genitourinary causes occurred frequently throughout the 30-day post-discharge period. Our data suggests further study is needed, perhaps on the value of closer monitoring in SNFs post-hospital discharge and improved communication between hospitals and SNFs, to reduce the risk of potentially preventable hospital readmissions.
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Affiliation(s)
- Melissa R. Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States of America
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States of America
| | - Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States of America
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States of America
| | - Joe B. B. Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States of America
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States of America
| | - Barbara H. Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States of America
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States of America
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - Parag Goyal
- Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Emily T. O’Neil
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States of America
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States of America
| | - Robertus van Aalst
- Sanofi Pasteur, Swiftwater, PA, United States of America
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ayman Chit
- Sanofi Pasteur, Swiftwater, PA, United States of America
- Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States of America
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States of America
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States of America
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, United States of America
| | - Andrew R. Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States of America
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States of America
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, United States of America
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11
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Riester MR, Bosco E, Manthana R, Eliot M, Bardenheier BH, Silva JB, van Aalst R, Chit A, Loiacono MM, Gravenstein S, Zullo AR. Relationships between Community Virus Activity and Cardiorespiratory Rehospitalizations From Post-Acute Care. J Am Med Dir Assoc 2022; 23:1418-1423.e7. [PMID: 35085507 PMCID: PMC9308831 DOI: 10.1016/j.jamda.2021.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/28/2022]
Abstract
Objectives: Quantify the relationship between increasing influenza and respiratory syncytial virus (RSV) community viral activity and cardiorespiratory rehospitalizations among older adults discharged to skilled nursing facilities (SNFs). Design: Retrospective cohort. Setting and Participants: Adults aged ≥65 years who were hospitalized and then discharged to a US SNF between 2012 and 2015. Methods: We linked Medicare Provider Analysis and Review claims to Minimum Data Set version 3.0 assessments, PRISM Climate Group data, and the Centers for Disease Control and Prevention viral testing data. All data were aggregated to US Department of Health and Human Services regions. Negative binomial regression models quantified the relationship between increasing viral activity for RSV and 3 influenza strains (H1N1pdm09, H3N2, and B) and cardiorespiratory rehospitalizations from SNFs. Incidence rate ratios described the relationship between a 5% increase in circulating virus and the rates of rehospitalization for cardiorespiratory outcomes. Analyses were repeated using the same model, but influenza and RSV were considered “in season” or “out of season” based on a 10% positive testing threshold. Results: Cardiorespiratory rehospitalization rates increased by approximately 1% for every 5% increase in circulating influenza A(H3N2), influenza B, and RSV, but decreased by 1% for every 5% increase in circulating influenza A(H1N1pdm09). When respiratory viruses were in season (vs out of season), cardiorespiratory rehospitalization rates increased by approximately 6% for influenza A(H3N2), 3% for influenza B, and 5% for RSV, but decreased by 6% for influenza A(H1N1pdm09). Conclusions and Implications: The respiratory season is a particularly important period to implement interventions that reduce cardiorespiratory hospitalizations among SNF residents. Decreasing viral transmission in SNFs through practices such as influenza vaccination for residents and staff, use of personal protective equipment, improved environmental cleaning measures, screening and testing of residents and staff, surveillance of viral activity, and quarantining infected individuals may be potential strategies to limit viral infections and associated cardiorespiratory rehospitalizations.
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12
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Bardenheier BH, Gravenstein S, Blackman C, Gutman R, Sarkar IN, Feifer RA, White EM, McConeghy K, Nanda A, Bosco E, Mor V. Adverse Events Following One Dose of mRNA COVID-19 Vaccination Among US Nursing Home Residents With and Without a Previous SARS-CoV-2 Infection. J Am Med Dir Assoc 2021; 22:2228-2232. [PMID: 34534492 PMCID: PMC8397576 DOI: 10.1016/j.jamda.2021.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To compare rates of adverse events following Coronavirus Disease 2019 (COVID-19) vaccination among nursing home residents with and without previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. DESIGN Prospective cohort. SETTING AND PARTICIPANTS A total of 20,918 nursing home residents who received the first dose of messenger RNA COVID-19 vaccine from December 18, 2020, through February 14, 2021, in 284 facilities within Genesis Healthcare, a large nursing home provider spanning 24 US states. METHODS We screened the electronic health record for adverse events, classified by the Brighton Collaboration, occurring within 15 days of a resident's first COVID-19 vaccine dose. All events were confirmed by physician chart review. To obtain risk ratios, multilevel logistic regression model that accounted for clustering (variability) across nursing homes was implemented. To balance the probability of prior SARS-CoV-2 infection (previous positive test or diagnosis by the International Classification of Diseases, 10th Revision, Clinical Modification) more than 20 days before vaccination, we used inverse probability weighting. To adjust for multiplicity of adverse events tested, we used a false discovery rate procedure. RESULTS Statistically significant differences existed between those without (n = 13,163) and with previous SARS-CoV-2 infection [symptomatic (n = 5617) and asymptomatic (n = 2138)] for all baseline characteristics assessed. Only 1 adverse event was reported among those with previous SARS-CoV-2 infection (asymptomatic), venous thromboembolism [46.8 per 100,000 residents 95% confidence interval (CI) 8.3-264.5], which was not significantly different from the rate reported for those without previous infection (30.4 per 100,000 95% CI 11.8-78.1). Several other adverse events were observed for those with no previous infection, but were not statistically significantly higher than those reported with previous infection after adjustments for multiple comparisons. CONCLUSIONS AND IMPLICATIONS Although reactogenicity increases with preexisting immunity, we did not find that vaccination among those with previous SARS-CoV-2 infection resulted in higher rates of adverse events than those without previous infection. This study stresses the importance of monitoring novel vaccines for adverse events in this vulnerable population.
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Affiliation(s)
| | - Stefan Gravenstein
- Brown University School of Public Health, Providence, RI, USA; Warren Alpert Medical School, Brown University, Providence, RI, USA; Providence Veterans Administration Medical Center, Providence, RI, USA
| | | | - Roee Gutman
- Brown University School of Public Health, Providence, RI, USA
| | - Indra Neil Sarkar
- Warren Alpert Medical School, Brown University, Providence, RI, USA; Rhode Island Quality Institute, Providence, RI, USA
| | | | | | - Kevin McConeghy
- Brown University School of Public Health, Providence, RI, USA; Providence Veterans Administration Medical Center, Providence, RI, USA
| | - Aman Nanda
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Elliott Bosco
- Brown University School of Public Health, Providence, RI, USA
| | - Vincent Mor
- Brown University School of Public Health, Providence, RI, USA
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13
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Silva JBB, Bosco E, Riester MR, McConeghy KW, Moyo P, van Aalst R, Bardenheier BH, Gravenstein S, Baier R, Loiacono MM, Chit A, Zullo AR. Geographic variation in influenza vaccination among U.S. nursing home residents: A national study. J Am Geriatr Soc 2021; 69:2536-2547. [PMID: 34013979 PMCID: PMC8242857 DOI: 10.1111/jgs.17270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
Objectives Estimates of influenza vaccine use are not available at the county level for U.S. nursing home (NH) residents but are critically necessary to guide the implementation of quality improvement programs aimed at increasing vaccination. Furthermore, estimates that account for differences in resident characteristics between counties are unavailable. We estimated risk‐standardized vaccination rates (RSVRs) among short‐ and long‐stay NH residents by U.S. county and identified drivers of geographic variation. Methods We conducted a retrospective cohort study utilizing 100% of 2013–2015 fee‐for‐service Medicare claims, Minimum Data Set assessments, Certification and Survey Provider Enhanced Reports, and Long‐Term Care: Facts on Care in the U.S. We separately evaluated short‐stay (<100 days) and long‐stay (≥100 days) residents aged 65 and older across the 2013–2014 and 2014–2015 influenza seasons. We estimated RSVRs via hierarchical logistic regression adjusting for 32 resident‐level covariates. We then used multivariable linear regression models to assess associations between county‐level NHs predictors and RSVRs. Results The study cohort consisted of 2,817,217 residents in 14,658 NHs across 2798 counties. Short‐stay residents had lower RSVRs than long‐stay residents (2013–2014: median [interquartile range], 69.6% [62.8–74.5] vs 84.0% [80.8–86.4]), and there was wide variation within each population (range, 11.4–89.8 vs 49.1–92.6). Several modifiable facility‐level characteristics were associated with increased RSVRs, including higher registered nurse to total nurse ratio and higher total staffing for licensed practical nurses, speech‐language pathologists, and social workers. Characteristics associated with lower RSVRs included higher percentage of residents restrained, with a pressure ulcer, and NH‐level hospitalizations per resident‐year. Conclusions Substantial county‐level variation in influenza vaccine use exists among short‐ and long‐stay NH residents. Quality improvement interventions to improve vaccination rates can leverage these results to target NHs located in counties with lower risk‐standardized vaccine use.
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Affiliation(s)
- Joe B B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kevin W McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Robertus van Aalst
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA.,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Rosa Baier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Matthew M Loiacono
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA.,Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Ayman Chit
- Sanofi Pasteur, Swiftwater, Pennsylvania, USA.,Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
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14
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Mor V, Gutman R, Yang X, White EM, McConeghy KW, Feifer RA, Blackman CR, Kosar CM, Bardenheier BH, Gravenstein SA. Short-term impact of nursing home SARS-CoV-2 vaccinations on new infections, hospitalizations, and deaths. J Am Geriatr Soc 2021; 69:2063-2069. [PMID: 33861873 PMCID: PMC8251275 DOI: 10.1111/jgs.17176] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 11/29/2022]
Abstract
Objective To compare rates of incident SARS‐CoV‐2 infection and 30‐day hospitalization or death among residents with confirmed infection in nursing homes with earlier versus later SARS‐CoV‐2 vaccine clinics. Design Matched pairs analysis of nursing homes that had their initial vaccine clinics between December 18, 2020, and January 2, 2021, versus between January 3, 2021, and January 18, 2021. Matched facilities had their initial vaccine clinics between 12 and 16 days apart. Setting and Participants Two hundred and eighty nursing homes in 21 states owned and operated by the largest long‐term care provider in the United States. Measurements Incident SARS‐CoV‐2 infections per 100 at‐risk residents per week; hospital transfers and/or deaths per 100 residents with confirmed SARS‐CoV‐2 infection per day, averaged over a week. Results The early vaccinated group included 136 facilities with 12,157 residents; the late vaccinated group included 144 facilities with 13,221 residents. After 1 week, early vaccinated facilities had a predicted 2.5 fewer incident SARS‐CoV‐2 infections per 100 at‐risk residents per week (95% CI: 1.2–4.0) compared with what would have been expected based on the experience of the late vaccinated facilities. The rates remained significantly lower for several weeks. Cumulatively over 5 weeks, the predicted reduction in new infections was 5.2 cases per 100 at‐risk residents (95% CI: 3.2–7.3). By 5 to 8 weeks post‐vaccine clinic, early vaccinated facilities had a predicted 1.1 to 3.8 fewer hospitalizations and/or deaths per 100 infected residents per day, averaged by week than expected based on late vaccinated facilities' experience for a cumulative on average difference of 5 events per 100 infected residents per day. Conclusions The SARS‐CoV‐2 vaccines seem to have accelerated the rate of decline of incident infections, morbidity, and mortality in this large multi‐state nursing home population. See related editorial by Ouslander et al and related articles by Moore et al, Rudolph et al, and Domi et al. in this issue.
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Affiliation(s)
- Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Providence Veterans Administration Medical Center Research Service, Providence, Rhode Island, USA
| | - Roee Gutman
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Xiaofei Yang
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Elizabeth M White
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kevin W McConeghy
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Providence Veterans Administration Medical Center Research Service, Providence, Rhode Island, USA
| | | | | | - Cyrus M Kosar
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Stefan A Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Providence Veterans Administration Medical Center Research Service, Providence, Rhode Island, USA.,Division of Geriatrics and Palliative Medicine, Brown University Alpert Medical School, Providence, Rhode Island, USA
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15
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Riester MR, Bosco E, Bardenheier BH, Moyo P, Baier RR, Eliot M, Silva JB, Gravenstein S, van Aalst R, Chit A, Loiacono MM, Zullo AR. Decomposing Racial and Ethnic Disparities in Nursing Home Influenza Vaccination. J Am Med Dir Assoc 2021; 22:1271-1278.e3. [PMID: 33838115 DOI: 10.1016/j.jamda.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Quantify how observable characteristics contribute to influenza vaccination disparities among White, Black, and Hispanic nursing home (NH) residents. DESIGN Retrospective cohort. SETTING AND PARTICIPANTS Short- and long-stay U.S. NH residents aged ≥65 years. METHODS We linked Minimum Data Set (MDS) and Medicare data to LTCFocUS and other facility data. We included residents with 6-month continuous enrollment in Medicare and an MDS assessment between October 1, 2013, and March 31, 2014. Residents were classified as short-stay (<100 days in NH) or long-stay (≥100 days in NH). We fit multivariable logistic regression models to assess the relationships between 27 resident and NH-level characteristics and receipt of influenza vaccination. Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparity in influenza vaccination between White versus Black and White versus Hispanic NH residents. Analyses were repeated separately for short- and long-stay residents. RESULTS Our study included 630,373 short-stay and 1,029,593 long-stay residents. Proportions vaccinated against influenza included 67.2% of White, 55.1% of Black, and 54.5% of Hispanic individuals among short-stay residents and 84.2%, 76.7%, and 80.8%, respectively among long-stay residents. Across 4 comparisons, the crude disparity in influenza vaccination ranged from 3.4 to 12.7 percentage points. By equalizing 27 prespecified characteristics, these disparities could be reduced 37.7% to 59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors across all analyses. Characteristics unmeasured in our data (eg, NH staff attitudes and beliefs) may have also contributed significantly to the disparity. CONCLUSIONS AND IMPLICATIONS The racial/ethnic disparity in influenza vaccination was most dramatic among short-stay residents. Intervening on factors associated with NH quality would likely reduce these disparities; however, future qualitative research is essential to explore potential contributors that were unmeasured in our data and to understand the degree to which these factors contribute to the overall disparity in influenza vaccination.
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Affiliation(s)
- Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Rosa R Baier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Center for Long-Term Care Quality and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Melissa Eliot
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Joe B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Robertus van Aalst
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Swiftwater, PA, USA; Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ayman Chit
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Swiftwater, PA, USA; Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada
| | - Matthew M Loiacono
- Vaccine Epidemiology and Modeling, Sanofi Pasteur, Swiftwater, PA, USA; Leslie Dan School of Pharmacy, University of Toronto, Ontario, Canada
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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Bardenheier BH, Wu WC, Zullo AR, Gravenstein S, Gregg EW. Progression to diabetes by baseline glycemic status among middle-aged and older adults in the United States, 2006-2014. Diabetes Res Clin Pract 2021; 174:108726. [PMID: 33662490 DOI: 10.1016/j.diabres.2021.108726] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
AIMS Primary prevention studies have indicated that structured lifestyle change programs in adults with an annual diabetes risk of 4.7% are cost-effective. However, few population-based studies have quantified the risk of diabetes among adults with prediabetes. METHODS We used the nationally representative U.S. Health and Retirement Study to identify adults aged ≥ 52 years with prediabetes (A1c: 5.7% - 6.4%) in 2006 and followed them to 2014 to assess diabetes status defined by A1c ≥ 6.5% in 2010 or 2014 or by self-report of a diabetes diagnosis by various risk factors. RESULTS Among the 1,406 adults with prediabetes (average 4.7 years of follow-up), risk factors significantly associated with subsequent incident diabetes with adjusted annual risk of diabetes ≥ 4.7% were: male gender (4.8%); aged 52-64 years (5.0%); Black race (5.5%); obesity (body mass index (kg/m2) ≥ 30.0, 6.8%); large waist circumference (women: > 35 in.; men: > 40 in., 4.9%); C-reactive protein levels ≥ 3 ug/L (5.5%); treated for high cholesterol (4.7%); treated for hypertension (5.3%); and moderate mobility loss (4.8%). CONCLUSIONS Primary prevention interventions among adults with prediabetes who also have moderate mobility loss or well-known risk factors for diabetes are likely to be cost-effective.
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Affiliation(s)
- Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
| | - Wen-Chih Wu
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA|Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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Bardenheier BH, Rahman M, Kosar C, Werner RM, Mor V. Successful Discharge to Community Gap of FFS Medicare Beneficiaries With and Without ADRD Narrowed. J Am Geriatr Soc 2021; 69:972-978. [PMID: 33300605 PMCID: PMC8049962 DOI: 10.1111/jgs.16965] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES We sought to compare the post-acute and long-term care experience of Medicare beneficiaries with and without Alzheimer Disease and Related Dementias (ADRD), and whether differences changed from January 1, 2007 to September 30, 2015. DESIGN Retrospective cross-sectional trend study using Medicare claims linked to the Centers for Medicare & Medicaid Services' (CMS) Minimum Data Set. SETTING CMS-certified skilled nursing facilities (skilled nursing facility (SNF), n = 17,043). PARTICIPANTS Fee-for-service Medicare beneficiaries aged ≥66 years (n = 6,614,939) discharged from a hospital to a SNF who had not lived in a nursing home during the year before hospitalization. MEASUREMENTS ADRD was defined by the Chronic Condition Data Warehouse. Outcome measures included: (1) successful discharge defined as being in SNF less than 90 days, then discharged back to the community, alive without subsequent inpatient health care for 30 continuous days; (2) became long-stay resident in SNF; (3) death in SNF within 90 days; (4) hospital readmission within 30 days of entering SNF; and (5) transferred to another nursing home within 30 days of entering SNF. RESULTS Successful discharge of beneficiaries with ADRD increased from 43.4% in 2007 to 53.9% in 2015 (average annual percent change (AAPC) = 2.1 (95% CI = 2.0-2.2)); those without ADRD also increased (from 59.1% to 63.6%, AAPC = 0.9 (95% CI = 0.7-1.1)) but not as fast as those with ADRD (P < .01). The proportion of all beneficiaries who became long-stay or were readmitted to the hospital decreased (P < .05). The proportion with ADRD who became long-stay was nearly three times higher than those without throughout the study (15.0% vs 5.5% in 2007; 11.3% vs 4.3% in 2015). CONCLUSION Though disparity in ADRD in becoming long-stay residents remains, the increase in successful discharges among those with ADRD also stresses the increasing importance of community as a care setting for adults with ADRD.
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Affiliation(s)
- Barbara H. Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Momotazur Rahman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Cyrus Kosar
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
| | - Rachel M. Werner
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island
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Bardenheier BH, Baier RR, Silva JB, Gravenstein S, Moyo P, Bosco E, Ogarek J, van Aalst R, Chit A, Zullo AR. Persistence of Racial Inequities in Receipt of Influenza Vaccination among Nursing Home Residents in the United States. Clin Infect Dis 2020; 73:e4361-e4368. [PMID: 32990309 PMCID: PMC8662763 DOI: 10.1093/cid/ciaa1484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 11/13/2022] Open
Abstract
Background We sought to determine if racial differences in influenza vaccination among nursing home (NH) residents during the 2008–2009 influenza season persisted in 2018–2019. Methods We conducted a cross-sectional study of NHs certified by the Centers for Medicare & Medicaid Services during the 2018–2019 influenza season in US states with ≥1% Black NH residents and a White–Black gap in influenza vaccination of NH residents (N = 2 233 392) of at least 1 percentage point (N = 40 states). NH residents during 1 October 2018 through 31 March 2019 aged ≥18 years and self-identified as being of Black or White race were included. Residents’ influenza vaccination status (vaccinated, refused, and not offered) was assessed. Multilevel modeling was used to estimate facility-level vaccination status and inequities by state. Results The White–Black gap in influenza vaccination was 9.9 percentage points. In adjusted analyses, racial inequities in vaccination were more prominent at the facility level than at the state level. Black residents disproportionately lived in NHs that had a majority of Blacks residents, which generally had the lowest vaccination. Inequities were most concentrated in the Midwestern region, also the most segregated. Not being offered the vaccine was negligible in absolute percentage points between White residents (2.6%) and Black residents (4.8%), whereas refusals were higher among Black (28.7%) than White residents (21.0%). Conclusions The increase in the White–Black vaccination gap among NH residents is occurring at the facility level in more states, especially those with the most segregation.
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Affiliation(s)
- Barbara H Bardenheier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Providence, RI, USA
| | - Rosa R Baier
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.,Center for Long-Term Care Quality & Innovation, Providence, RI, USA
| | - Joe B Silva
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Providence, RI, USA.,Center for Long-Term Care Quality & Innovation, Providence, RI, USA.,Center of Innovation in Long-Term Services and Supports, Providence, RI, USA.,Providence Veterans Affairs Medical Center, Providence, RI, USA.,Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Elliott Bosco
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.,Center for Gerontology and Healthcare Research, Providence, RI, USA
| | - Jessica Ogarek
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Robertus van Aalst
- Sanofi Pasteur, Swiftwater, PA USA.,Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ayman Chit
- Sanofi Pasteur, Swiftwater, PA USA.,Leslie Dan School of Pharmacy, University of Toronto, Toronto, Ontario Canada
| | - Andrew R Zullo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Center of Innovation in Long-Term Services and Supports, Providence, RI, USA.,Providence Veterans Affairs Medical Center, Providence, RI, USA.,Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
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Bardenheier BH, Lindley MC, Ball SW, de Perio MA, Laney S, Gravenstein S. Cluster Analysis: Vaccination Attitudes and Beliefs of Healthcare Personnel. Am J Health Behav 2020; 44:302-312. [PMID: 32295678 PMCID: PMC9987325 DOI: 10.5993/ajhb.44.3.3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: We sought to identify patterns of knowledge, attitudes, and behaviors (KABs) about influenza and influenza vaccination among healthcare personnel (HCP) and define characteristics associated with these patterns. Methods: We used an Internet panel survey of HCP (N = 2265) during March 27-April 17, 2018; clustered HCP by their vaccination-related KABs. Results: Four clusters were identified: Immunization Champions (61.1% of the sample) received influenza vaccine to prevent disease; Unworried Vaccinators (15.4%) received the influenza vaccine but did not believe influenza is a serious threat to themselves; Fence Sitters (8.1%) believed the vaccine is safe and worth the time and expense but is not effective; Skeptics (15.4%) did not believe the vaccine is safe or effective. Influenza vaccination coverage was 78.4% overall and higher among Immunization Champions (90.2%) and Unworried Vaccinators (87.0%) than Fence Sitters (61.6%) or Skeptics (32.2%). Conclusions: Findings suggest that based on KABs, the 3 clusters comprising 85% of HCP might be vaccinated in the future. Using messages specific to each group may improve vaccination coverage among HCP.
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Affiliation(s)
- Barbara H Bardenheier
- Barbara Bardenheier, Assistant Professor, Brown University, Department of Health Services, Policy and Practice, Providence, RI;,
| | - Megan C Lindley
- Megan Lindley, Deputy Associate Director for Science, Immunization Services Division, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah W Ball
- Sarah Ball, Consultant, Abt Associates, Cambridge, MA
| | - Marie A de Perio
- Marie de Perio, Medical Epidemiologist, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Scott Laney
- Scott Laney, Epidemiologist, National Institute for Occupational Safety and Health, Cincinnati, OH
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Lindley MC, Kahn KE, Bardenheier BH, D’Angelo DV, Dawood FS, Fink RV, Havers F, Skoff TH. Vital Signs: Burden and Prevention of Influenza and Pertussis Among Pregnant Women and Infants - United States. MMWR Morb Mortal Wkly Rep 2019; 68:885-892. [PMID: 31600186 PMCID: PMC6788399 DOI: 10.15585/mmwr.mm6840e1] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Vaccinating pregnant women with influenza vaccine and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) can reduce influenza and pertussis risk for themselves and their infants. Methods Surveillance data were analyzed to ascertain influenza-associated hospitalization among pregnant women and infant hospitalization and death associated with influenza and pertussis. An Internet panel survey was conducted during March 27–April 8, 2019, among women aged 18–49 years who reported being pregnant any time since August 1, 2018. Influenza vaccination before or during pregnancy was assessed among respondents with known influenza vaccination status who were pregnant any time during October 2018–January 2019 (2,097). Tdap receipt during pregnancy was assessed among respondents with known Tdap status who reported a live birth by their survey date (817). Results From 2010–11 to 2017–18, pregnant women accounted for 24%–34% of influenza-associated hospitalizations per season among females aged 15–44 years. From 2010 to 2017, a total of 3,928 pertussis-related hospitalizations were reported among infants aged <2 months (annual range = 262–743). Maternal influenza and Tdap vaccination coverage rates reported as of April 2019 were 53.7% and 54.9%, respectively. Among women whose health care providers offered vaccination or provided referrals, 65.7% received influenza vaccine and 70.5% received Tdap. The most commonly reported reasons for nonvaccination were believing the vaccine is not effective (influenza; 17.6%) and not knowing that vaccination is needed during each pregnancy (Tdap; 37.9%), followed by safety concerns for the infant (influenza =15.9%; Tdap = 17.1%). Conclusions and Implications for Public Health Practice Many pregnant women do not receive the vaccines recommended to protect themselves and their infants, even when vaccination is offered. CDC and provider organizations’ resources are available to help providers convey strong, specific recommendations for influenza and Tdap vaccination that are responsive to pregnant women’s concerns.
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Iqbal SA, Winston CA, Bardenheier BH, Armstrong LR, Navin TR. Age-Period-Cohort Analyses of Tuberculosis Incidence Rates by Nativity, United States, 1996-2016. Am J Public Health 2019; 108:S315-S320. [PMID: 30383432 DOI: 10.2105/ajph.2018.304687] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess changes in US tuberculosis (TB) incidence rates by age, period, and cohort effects, stratified according to race/ethnicity and nativity. METHODS We used US National Tuberculosis Surveillance System data for 1996 to 2016 to estimate trends through age-period-cohort models. RESULTS Controlling for cohort and period effects indicated that the highest rates of TB incidence occurred among those 0 to 5 and 20 to 30 years of age. The incidence decreased by age for successive birth cohorts. There were greater estimated annual percentage decreases among US-born individuals (-7.3%; 95% confidence interval [CI] = -7.5, -7.1) than among non-US-born individuals (-4.3%; 95% CI = -4.5, -4.1). US-born individuals older than 25 years exhibited the largest decreases, a pattern that was not reflected among non-US-born adults. In the case of race/ethnicity, the greatest decreases by nativity were among US-born Blacks (-9.3%; 95% CI = -9.6, -9.1) and non-US-born Hispanics (-5.7%; 95% CI = -6.0, -5.5). CONCLUSIONS TB has been decreasing among all ages, races and ethnicities, and consecutive cohorts, although these decreases are less pronounced among non-US-born individuals.
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Affiliation(s)
- Shareen A Iqbal
- Shareen A. Iqbal, Carla A. Winston, Lori R. Armstrong, and Thomas R. Navin are with the Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Barbara H. Bardenheier is with the Division of Global Migration and Quarantine, CDC
| | - Carla A Winston
- Shareen A. Iqbal, Carla A. Winston, Lori R. Armstrong, and Thomas R. Navin are with the Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Barbara H. Bardenheier is with the Division of Global Migration and Quarantine, CDC
| | - Barbara H Bardenheier
- Shareen A. Iqbal, Carla A. Winston, Lori R. Armstrong, and Thomas R. Navin are with the Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Barbara H. Bardenheier is with the Division of Global Migration and Quarantine, CDC
| | - Lori R Armstrong
- Shareen A. Iqbal, Carla A. Winston, Lori R. Armstrong, and Thomas R. Navin are with the Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Barbara H. Bardenheier is with the Division of Global Migration and Quarantine, CDC
| | - Thomas R Navin
- Shareen A. Iqbal, Carla A. Winston, Lori R. Armstrong, and Thomas R. Navin are with the Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Barbara H. Bardenheier is with the Division of Global Migration and Quarantine, CDC
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Bardenheier BH, McNeil MM, Wodi AP, McNicholl JM, DeStefano F. Risk of Nontargeted Infectious Disease Hospitalizations Among US Children Following Inactivated and Live Vaccines, 2005-2014. Clin Infect Dis 2018; 65:729-737. [PMID: 28481979 DOI: 10.1093/cid/cix442] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/05/2017] [Indexed: 01/06/2023] Open
Abstract
Background Recent studies have shown that some vaccines have beneficial effects that cannot be explained solely by the prevention of their respective targeted disease(s). Methods We used the MarketScan US Commercial Claims Databases for 2005 to 2014 to assess the risk of hospital admission for nontargeted infectious (NTI) diseases in children aged 16 through 24 months according to the last vaccine type (live and/or inactivated). We included children continuously enrolled within a month of birth through 15 months who received at least 3 doses of diphtheria-tetanus-acellular pertussis vaccine by the end of 15 months of age. We used Cox regression to estimate hazard ratios (HRs), stratifying by birthdate to control for age, year, and seasonality and adjusting for sex, chronic diseases, prior hospitalizations, number of outpatient visits, region of residence, urban/rural area of domicile, prematurity, low birth weight, and mother's age. Results 311663 children were included. In adjusted analyses, risk of hospitalization for NTI from ages 16 through 24 months was reduced for those who received live vaccine alone compared with inactivated alone or concurrent live and inactivated vaccines (HR, 0.50; 95% confidence interval [CI], 0.43, 0.57 and HR, 0.78; 95% CI, 0.67, 0.91, respectively) and for those who received live and inactivated vaccines concurrently compared with inactivated-only (HR, 0.64; 95% CI, 0.58, 0.70). Conclusions We found lower risk of NTI disease hospitalizations from age 16 through 24 months among children whose last vaccine received was live compared with inactivated vaccine, as well as concurrent receipt compared with inactivated vaccine.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael M McNeil
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - A Patricia Wodi
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet M McNicholl
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bardenheier BH, McNeil MM, Wodi AP, McNicholl JM, DeStefano F. Reply to Burgner, et al. Clin Infect Dis 2018; 66:319. [DOI: 10.1093/cid/cix839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bardenheier BH, Duffy J, Duderstadt SK, Higgs JB, Keith MP, Papadopoulos PJ, Gilliland WR, McNeil MM. Anthrax Vaccine and the Risk of Rheumatoid Arthritis and Systemic Lupus Erythematosus in the U.S. Military: A Case-Control Study. Mil Med 2017; 181:1348-1356. [PMID: 27753574 DOI: 10.7205/milmed-d-15-00485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
U.S. military personnel assigned to areas deemed to be at high risk for anthrax attack receive Anthrax Vaccine Adsorbed (AVA). Few cases of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) have been reported in persons who received AVA. Using a matched case-control study design, we assessed the relationship of RA and SLE with AVA vaccination using the Defense Medical Surveillance System. We identified potential cases using International Classification of Diseases, 9th Revision, Clinical Modification codes and confirmed cases with medical record review and rheumatologist adjudication. Using conditional logistic regression, we estimated odds ratios (OR) for AVA exposure during time intervals ranging from 90 to 1,095 days before disease onset. Among 77 RA cases, 13 (17%) had ever received AVA. RA cases were no more likely than controls to have received AVA when looking back 1,095 days (OR: 1.03; 95% confidence interval [CI]: 0.48-2.19) but had greater odds of exposure in the prior 90 days (OR: 3.93; 95% CI: 1.08-14.27). Among the 39 SLE cases, 5 (13%) had ever received AVA; no significant difference in receipt of AVA was found when compared with controls (OR: 0.91; 95% CI: 0.26-3.25). AVA was associated with recent onset RA, but did not increase the risk of developing RA in the long term.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - Jonathan Duffy
- Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - Susan K Duderstadt
- Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333
| | - Jay B Higgs
- Rheumatology Service, Brooke Army Medical Center, 3851 Roger Brooke Drive, San Antonio, TX 78234
| | - Michael P Keith
- Rheumatology Service, Walter Reed National Military Medical Center, 4954 N. Palmer Road, Bethesda, MD 20889-5600
| | | | - William R Gilliland
- Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Room A 1005, Bethesda, MD 20814
| | - Michael M McNeil
- Immunization Safety Office, MS D-26, 1600 Clifton Road NE, Centers for Disease Control and Prevention, Atlanta, GA 30333
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Bardenheier BH, Lin J, Zhuo X, Ali MK, Thompson TJ, Cheng YJ, Gregg EW. Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis. Lancet Diabetes Endocrinol 2016; 4:686-694. [PMID: 27298181 PMCID: PMC4959005 DOI: 10.1016/s2213-8587(16)30090-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years. METHODS In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years. FINDINGS In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0·8-2·3 year delay in disability across the three metrics (mobility, 63·0 [95% CI 62·3-63·6] to 64·8 [63·6-65·7], p=0·01; instrumental activities of daily living, 63·5 [63·0-64·0] to 64·3 [63·0-65·3], p=0·24; activities of daily living, 62·7 [62·1-63·3] to 65·0 [63·5-65·9], p<0·0001) and 1·3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2·8 [2·5-3·2] to 1·5 [1·3-1·9]; p<0·0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1·1-2·3 year delay in disability across the three metrics (mobility, 61·3 [95% CI 60·5-62·1] to 63·2 [61·5-64·5], p=0·0416; instrumental activities of daily living, 63·0 [62·4-63·7] to 64·1 [62·7-65·2], p=0·16; activities of daily living, 62·3 [61·6-63·0] to 64·6 [63·1-65·6], p<0·0001) and 0·8 fewer life-years lost by age 70 years (1·9 [1·7-2·2] to 1·1 [0·9-1·5]; p<0·0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0·0001 for all comparisons). INTERPRETATION Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years. FUNDING US Department of Health & Human Services and the US Centers for Disease Control and Prevention.
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Affiliation(s)
- Barbara H Bardenheier
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA; Immunization Safety Office, US Centers for Disease Control and Prevention, Atlanta, GA.
| | - Ji Lin
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Xiaohui Zhuo
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA; Merck and Co, North Wales, PA, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Theodore J Thompson
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Yiling J Cheng
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, US Centers for Disease Control and Prevention, Atlanta, GA
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Bardenheier BH, Duderstadt SK, Engler RJM, McNeil MM. Adverse events following pandemic influenza A (H1N1) 2009 monovalent and seasonal influenza vaccinations during the 2009-2010 season in the active component U.S. military and civilians aged 17-44years reported to the Vaccine Adverse Event Reporting System. Vaccine 2016; 34:4406-14. [PMID: 27449076 DOI: 10.1016/j.vaccine.2016.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND No comparative review of Vaccine Adverse Event Reporting System (VAERS) submissions following pandemic influenza A (H1N1) 2009 and seasonal influenza vaccinations during the pandemic season among U.S. military personnel has been published. METHODS We compared military vs. civilian adverse event reporting rates. Adverse events (AEs) following vaccination were identified from VAERS for adults aged 17-44years after pandemic (monovalent influenza [MIV], and seasonal (trivalent inactivated influenza [IIV3], live attenuated influenza [LAIV3]) vaccines. Military vaccination coverage was provided by the Department of Defense's Defense Medical Surveillance System. Civilian vaccination coverage was estimated using data from the National 2009 H1N1 Flu Survey and the Behavioral Risk Factor Surveillance System survey. RESULTS Vaccination coverage was more than four times higher for MIV and more than twenty times higher for LAIV3 in the military than in the civilian population. The reporting rate of serious AE reports following MIV in service personnel (1.19 per 100,000) was about half that reported by the civilian population (2.45 per 100,000). Conversely, the rate of serious AE reports following LAIV3 among service personnel (1.32 per 100,000) was more than twice that of the civilian population. Although fewer military AEs following MIV were reported overall, the rate of Guillain-Barré Syndrome (GBS) (4.01 per million) was four times greater than that in the civilian population. (1.04 per million). CONCLUSIONS Despite higher vaccination coverage in service personnel, the rate of serious AEs following MIV was about half that in civilians. The rate of GBS reported following MIV was higher in the military.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Safety Office, Centers for Disease Control & Prevention, Atlanta, GA 30333, United States
| | - Susan K Duderstadt
- Immunization Safety Office, Centers for Disease Control & Prevention, Atlanta, GA 30333, United States
| | - Renata J M Engler
- Immunization Healthcare Branch, Defense Health Agency, (including legacy Vaccine Healthcare Centers Network, Public Health Command), Walter Reed National Military Medical Center America, 8901 Wisconsin Avenue, Bethesda, MA 20889-0001, United States
| | - Michael M McNeil
- Immunization Safety Office, Centers for Disease Control & Prevention, Atlanta, GA 30333, United States.
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Bardenheier BH, Lin J, Zhuo X, Ali MK, Thompson TJ, Cheng YJ, Gregg EW. Disability-Free Life-Years Lost Among Adults Aged ≥50 Years With and Without Diabetes. Diabetes Care 2016; 39:1222-9. [PMID: 26721810 PMCID: PMC5884095 DOI: 10.2337/dc15-1095] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 11/02/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To quantify the impact of diabetes status on healthy and disabled years of life for older adults in the U.S. and provide a baseline from which to evaluate ongoing national public health efforts to prevent and control diabetes and disability. RESEARCH DESIGN AND METHODS Adults (n = 20,008) aged 50 years and older were followed from 1998 to 2012 in the Health and Retirement Study, a prospective biannual survey of a nationally representative sample of adults. Diabetes and disability status (defined by mobility loss, difficulty with instrumental activities of daily living [IADL], and/or difficulty with activities of daily living [ADL]) were self-reported. We estimated incidence of disability, remission to nondisability, and mortality. We developed a discrete-time Markov simulation model with a 1-year transition cycle to predict and compare lifetime disability-related outcomes between people with and without diabetes. Data represent the U.S. population in 1998. RESULTS From age 50 years, adults with diabetes died 4.6 years earlier, developed disability 6-7 years earlier, and spent about 1-2 more years in a disabled state than adults without diabetes. With increasing baseline age, diabetes was associated with significant (P < 0.05) reductions in the number of total and disability-free life-years, but the absolute difference in years between those with and without diabetes was less than at younger baseline age. Men with diabetes spent about twice as many of their remaining years disabled (20-24% of remaining life across the three disability definitions) as men without diabetes (12-16% of remaining life across the three disability definitions). Similar associations between diabetes status and disability-free and disabled years were observed among women. CONCLUSIONS Diabetes is associated with a substantial reduction in nondisabled years, to a greater extent than the reduction of longevity.
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Affiliation(s)
- Barbara H Bardenheier
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ji Lin
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xiaohui Zhuo
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA Merck & Co., North Wales, PA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Theodore J Thompson
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yiling J Cheng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Marshall GN, Schell TL, Wong EC, Berthold SM, Hambarsoomian K, Elliott MN, Bardenheier BH, Gregg EW. Diabetes and Cardiovascular Disease Risk in Cambodian Refugees. J Immigr Minor Health 2016; 18:110-7. [PMID: 25651882 PMCID: PMC4526445 DOI: 10.1007/s10903-014-0142-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED To determine rates of diabetes, hypertension, and hyperlipidemia in Cambodian refugees, and to assess the proportion whose conditions are satisfactorily managed in comparison to the general population. Self-report and laboratory/physical health assessment data obtained from a household probability sample of U.S.-residing Cambodian refugees (N = 331) in 2010-2011 were compared to a probability sample of the adult U.S. population (N = 6,360) from the 2009-2010 National Health and Nutrition Examination Survey. Prevalence of diabetes, hypertension and hyperlipidemia in Cambodian refugees greatly exceeded rates found in the age- and gender-adjusted U.S. POPULATION Cambodian refugees with diagnosed hypertension or hyperlipidemia were less likely than their counterparts in the general U.S. population to have blood pressure and total cholesterol within recommended levels. Increased attention should be paid to prevention and management of diabetes and cardiovascular disease risk factors in the Cambodian refugee community. Research is needed to determine whether this pattern extends to other refugee groups.
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Affiliation(s)
- Grant N Marshall
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA.
| | - Terry L Schell
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - Eunice C Wong
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - S Megan Berthold
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
- University of Connecticut, West Hartford, CT, USA
| | | | - Marc N Elliott
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
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Brinks R, Bardenheier BH, Hoyer A, Lin J, Landwehr S, Gregg EW. Development and demonstration of a state model for the estimation of incidence of partly undetected chronic diseases. BMC Med Res Methodol 2015; 15:98. [PMID: 26560517 PMCID: PMC4642685 DOI: 10.1186/s12874-015-0094-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/06/2015] [Indexed: 01/08/2023] Open
Abstract
Background Estimation of incidence of the state of undiagnosed chronic disease provides a crucial missing link for the monitoring of chronic disease epidemics and determining the degree to which changes in prevalence are affected or biased by detection. Methods We developed a four-part compartment model for undiagnosed cases of irreversible chronic diseases with a preclinical state that precedes the diagnosis. Applicability of the model is tested in a simulation study of a hypothetical chronic disease and using diabetes data from the Health and Retirement Study (HRS). Results A two dimensional system of partial differential equations forms the basis for estimating incidence of the undiagnosed and diagnosed disease states from the prevalence of the associated states. In the simulation study we reach very good agreement between the estimates and the true values. Application to the HRS data demonstrates practical relevance of the methods. Discussion We have demonstrated the applicability of the modeling framework in a simulation study and in the analysis of the Health and Retirement Study. The model provides insight into the epidemiology of undiagnosed chronic diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12874-015-0094-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ralph Brinks
- German Diabetes Center, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düsseldorf, 40225, Germany.
| | - Barbara H Bardenheier
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
| | - Annika Hoyer
- German Diabetes Center, Institute for Biometry and Epidemiology, Auf'm Hennekamp 65, Düsseldorf, 40225, Germany.
| | - Ji Lin
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
| | - Sandra Landwehr
- University Hospital, Department for Statistics in Medicine, Düsseldorf, Germany.
| | - Edward W Gregg
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, Georgia, United States of America.
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Bardenheier BH, Imperatore G, Gilboa SM, Geiss LS, Saydah SH, Devlin HM, Kim SY, Gregg EW. Trends in Gestational Diabetes Among Hospital Deliveries in 19 U.S. States, 2000-2010. Am J Prev Med 2015; 49:12-9. [PMID: 26094225 PMCID: PMC4532269 DOI: 10.1016/j.amepre.2015.01.026] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/23/2015] [Accepted: 01/30/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Diabetes is one of the most common and fastest-growing comorbidities of pregnancy. Temporal trends in gestational diabetes mellitus (GDM) have not been examined at the state level. This study examines GDM prevalence trends overall and by age, state, and region for 19 states, and by race/ethnicity for 12 states. Sub-analysis assesses trends among GDM deliveries by insurance type and comorbid hypertension in pregnancy. METHODS Using the Agency for Healthcare Research and Quality's National and State Inpatient Databases, deliveries were identified using diagnosis-related group codes for GDM and comorbidities using ICD-9-CM diagnosis codes among all community hospitals. General linear regression with a log-link and binomial distribution was used in 2014 to assess annual change in GDM prevalence from 2000 through 2010. RESULTS The age-standardized prevalence of GDM increased from 3.71 in 2000 to 5.77 per 100 deliveries in 2010 (relative increase, 56%). From 2000 through 2010, GDM deliveries increased significantly in all states (p<0.01), with relative increases ranging from 36% to 88%. GDM among deliveries in 12 states reporting race and ethnicity increased among all groups (p<0.01), with the highest relative increase in Hispanics (66%). Among GDM deliveries in 19 states, those with pre-pregnancy hypertension increased significantly from 2.5% to 4.1% (relative increase, 64%). The burden of GDM delivery payment shifted from private insurers (absolute decrease of 13.5 percentage points) to Medicaid/Medicare (13.2-percentage point increase). CONCLUSIONS Results suggest that GDM deliveries are increasing. The highest rates of increase are among Hispanics and among GDM deliveries complicated by pre-pregnancy hypertension.
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Affiliation(s)
- Barbara H Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion.
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Suzanne M Gilboa
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia
| | - Linda S Geiss
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Sharon H Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Heather M Devlin
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
| | - Shin Y Kim
- Division for Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion
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Abstract
OBJECTIVE Diabetes care has changed substantially in the past 2 decades. We examined the change in medical spending and use related to diabetes between 1987 and 2011. RESEARCH DESIGN AND METHODS Using the 1987 National Medical Expenditure Survey and the Medical Expenditure Panel Surveys in 2000-2001 and 2010-2011, we compared per person medical expenditures and uses among adults ≥ 18 years of age with or without diabetes at the three time points. Types of medical services included inpatient care, emergency room (ER) visits, outpatient visits, prescription drugs, and others. We also examined the changes in unit cost, defined by the expenditure per encounter for medical services. RESULTS The excess medical spending attributed to diabetes was $2,588 (95% CI, $2,265 to $3,104), $4,205 ($3,746 to $4,920), and $5,378 ($5,129 to $5,688) per person, respectively, in 1987, 2000-2001, and 2010-2011. Of the $2,790 increase, prescription medication accounted for 55%; inpatient visits accounted for 24%; outpatient visits accounted for 15%; and ER visits and other medical spending accounted for 6%. The growth in prescription medication spending was due to the increase in both the volume of use and unit cost, whereas the increase in outpatient expenditure was almost entirely driven by more visits. In contrast, the increase in inpatient and ER expenditures was caused by the rise of unit costs. CONCLUSIONS In the past 2 decades, managing diabetes has become more expensive, mostly due to the higher spending on drugs. Further studies are needed to assess the cost-effectiveness of increased spending on drugs.
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Affiliation(s)
- Xiaohui Zhuo
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Henry S Kahn
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Barbara H Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Rui Li
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Marshall GN, Schell TL, Wong EC, Berthold SM, Hambarsoomian K, Elliott MN, Bardenheier BH, Gregg EW. Diabetes and Cardiovascular Disease Risk in Cambodian Refugees. J Immigr Minor Health 2015. [DOI: 10.1007/s10903-014-0142-4 [doi]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
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Bardenheier BH, Imperatore G, Devlin HM, Kim SY, Cho P, Geiss LS. Trends in pre-pregnancy diabetes among deliveries in 19 U.S. states, 2000-2010. Am J Prev Med 2015; 48:154-161. [PMID: 25326417 PMCID: PMC4486010 DOI: 10.1016/j.amepre.2014.08.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/20/2014] [Accepted: 08/26/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Trends in state-level prevalence of pre-pregnancy diabetes mellitus (PDM; i.e., type 1 or type 2 diabetes diagnosed before pregnancy) among delivery hospitalizations are needed to inform healthcare delivery planning and prevention programs. PURPOSE To examine PDM trends overall, by age group, race/ethnicity, primary payer, and with comorbidities such as pre-eclampsia and pre-pregnancy hypertension, and to report changes in prevalence over 11 years. METHODS In 2014, State Inpatient Databases from the Agency for Healthcare Research and Quality were analyzed to identify deliveries with PDM and comorbidities using diagnosis-related group codes and ICD-9-CM codes. General linear regression with a log-link and binomial distribution was used to assess the annual change. RESULTS Between 2000 and 2010, PDM deliveries increased significantly in all age groups, all race/ethnicity groups, and in all states examined (p<0.01). The age-standardized prevalence of PDM increased from 0.65 per 100 deliveries in 2000 to 0.89 per 100 deliveries in 2010, with a relative change of 37% (p<0.01). Although PDM rates were highest in the South, some of the largest relative increases occurred in five Western states (≥69%). Non-Hispanic blacks had the highest PDM rates and the highest absolute increase (0.26 per 100 deliveries). From 2000 to 2010, the proportion of PDM deliveries with pre-pregnancy hypertension increased significantly (p<0.01) from 7.4% to 14.1%. CONCLUSIONS PDM deliveries are increasing overall and particularly among those with PDM who have hypertension. Effective diabetes prevention and control strategies for women of childbearing age may help protect their health and that of their newborns.
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Affiliation(s)
- Barbara H Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Heather M Devlin
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Shin Y Kim
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Pyone Cho
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
| | - Linda S Geiss
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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Simeone RM, Devine OJ, Marcinkevage JA, Gilboa SM, Razzaghi H, Bardenheier BH, Sharma AJ, Honein MA. Diabetes and congenital heart defects: a systematic review, meta-analysis, and modeling project. Am J Prev Med 2015; 48:195-204. [PMID: 25326416 PMCID: PMC4455032 DOI: 10.1016/j.amepre.2014.09.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 08/08/2014] [Accepted: 09/02/2014] [Indexed: 11/26/2022]
Abstract
CONTEXT Maternal pregestational diabetes (PGDM) is a risk factor for development of congenital heart defects (CHDs). Glycemic control before pregnancy reduces the risk of CHDs. A meta-analysis was used to estimate summary ORs and mathematical modeling was used to estimate population attributable fractions (PAFs) and the annual number of CHDs in the U.S. potentially preventable by establishing glycemic control before pregnancy. EVIDENCE ACQUISITION A systematic search of the literature through December 2012 was conducted in 2012 and 2013. Case-control or cohort studies were included. Data were abstracted from 12 studies for a meta-analysis of all CHDs. EVIDENCE SYNTHESIS Summary estimates of the association between PGDM and CHDs and 95% credible intervals (95% CrIs) were developed using Bayesian random-effects meta-analyses for all CHDs and specific CHD subtypes. Posterior estimates of this association were combined with estimates of CHD prevalence to produce estimates of PAFs and annual prevented cases. Ninety-five percent uncertainty intervals (95% UIs) for estimates of the annual number of preventable cases were developed using Monte Carlo simulation. Analyses were conducted in 2013. The summary OR estimate for the association between PGDM and CHDs was 3.8 (95% CrI=3.0, 4.9). Approximately 2670 (95% UI=1795, 3795) cases of CHDs could potentially be prevented annually if all women in the U.S. with PGDM achieved glycemic control before pregnancy. CONCLUSIONS Estimates from this analysis suggest that preconception care of women with PGDM could have a measureable impact by reducing the number of infants born with CHDs.
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Affiliation(s)
- Regina M Simeone
- National Center on Birth Defects and Developmental Disabilities; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.
| | - Owen J Devine
- National Center on Birth Defects and Developmental Disabilities
| | - Jessica A Marcinkevage
- National Center on Birth Defects and Developmental Disabilities; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Hilda Razzaghi
- National Center on Birth Defects and Developmental Disabilities; Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | | | - Andrea J Sharma
- National Center for Chronic Disease Prevention and Health Promotion, CDC; U.S. Public Health Service Commissioned Corps, Atlanta, Georgia
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Bardenheier BH, Cogswell ME, Gregg EW, Williams DE, Zhang Z, Geiss LS. Does knowing one's elevated glycemic status make a difference in macronutrient intake? Diabetes Care 2014; 37:3143-9. [PMID: 25205140 PMCID: PMC4535332 DOI: 10.2337/dc14-1342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether macronutrient intake differs by awareness of glycemic status among people with diabetes and prediabetes. RESEARCH DESIGN AND METHODS We used 24-h dietary recall and other data from 3,725 nonpregnant adults with diabetes or prediabetes aged ≥20 years from the morning fasting sample of the 2005-2010 National Health and Nutrition Examination Survey. Diabetes and prediabetes awareness were self-reported; those unaware of diabetes and prediabetes were defined by fasting plasma glucose (FPG) ≥126 mg/dL or HbA1c ≥6.5% and FPG 100-125 mg/dL or HbA1c of 5.7%-6.4%, respectively. Components of nutrient intake on a given day assessed were total calories, sugar, carbohydrates, fiber, protein, fat, and total cholesterol, stratified by sex and glycemic status awareness. Estimates of nutrient intake were adjusted for age, race/ethnicity, education level, BMI, smoking status, and family history of diabetes. RESULTS Men with diagnosed diabetes consumed less sugar (mean 86.8 vs. 116.8 g) and carbohydrates (mean 235.0 vs. 262.1 g) and more protein (mean 92.3 vs. 89.7 g) than men with undiagnosed diabetes. Similarly, women with diagnosed diabetes consumed less sugar (mean 79.1 vs. 95.7 g) and more protein (mean 67.4 vs. 56.6 g) than women with undiagnosed diabetes. No significant differences in macronutrient intake were found by awareness of prediabetes. All participants, regardless of sex or glycemic status, consumed on average less than the American Diabetes Association recommendations for fiber intake (i.e., 14 g/1,000 kcal) and slightly more saturated fat than recommended (>10% of total kcal). CONCLUSIONS Screening and subsequent knowledge of glycemic status may favorably affect some dietary patterns for people with diabetes.
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Affiliation(s)
- Barbara H Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mary E Cogswell
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Desmond E Williams
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Zefeng Zhang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Linda S Geiss
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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Bardenheier BH, Gregg EW, Zhuo X, Cheng YJ, Geiss LS. Association of functional decline with subsequent diabetes incidence in U.S. adults aged 51 years and older: the Health and Retirement Study 1998-2010. Diabetes Care 2014; 37:1032-8. [PMID: 24550218 DOI: 10.2337/dc13-2216] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed whether functional decline and physical disability increase the subsequent risk of diabetes. RESEARCH DESIGN AND METHODS We used a subsample of adults aged 51 years and older with no diabetes at baseline who were followed up to 12 years (1998-2010) in the Health and Retirement Study, an observational study of a nationally representative survey. We assessed baseline disability status and incident disability with subsequent risk of diabetes, accounting for death as a competing risk and controlling for BMI, age, sex, race/ethnicity, net wealth, mother's level of education, respondents' level of education, and time of follow-up. Disability was defined as none, mild, moderate, and severe, based on a validated scale of mobility measures. Diabetes was identified by self-report of a diagnosis from a doctor. Population attributable fraction (PAF) was calculated to assess the percentage of diabetes cases that were attributable to mobility disability. RESULTS The sample included 22,878 adults with an average of 8.7 years of follow-up; 9,649 (41.2%) reported some level of disability at baseline, and 8,175 (35.7%) additional participants developed disability during follow-up; 3,546 (15.5%) participants developed diabetes; and 5,869 (25.6%) died. Regression analyses found a statistically significant dose-response relationship of increased risk of diabetes (28-95%) among those with any level of functional decline, prevalent or incident. Among the subanalytic sample, including incident disability only, the PAF was 6.9% (CI 4.2-9.5). CONCLUSIONS Our findings suggest those who become disabled, even mildly, are at increased risk of developing diabetes. This finding raises the possibility that approaches to prevent disability in older adults could also reduce diabetes incidence.
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Bardenheier BH, Bullard KM, Caspersen CJ, Cheng YJ, Gregg EW, Geiss LS. A novel use of structural equation models to examine factors associated with prediabetes among adults aged 50 years and older: National Health and Nutrition Examination Survey 2001-2006. Diabetes Care 2013; 36:2655-62. [PMID: 23649617 PMCID: PMC3747946 DOI: 10.2337/dc12-2608] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To use structural modeling to test a hypothesized model of causal pathways related with prediabetes among older adults in the U.S. RESEARCH DESIGN AND METHODS Cross-sectional study of 2,230 older adults (≥ 50 years) without diabetes included in the morning fasting sample of the 2001-2006 National Health and Nutrition Examination Surveys. Demographic data included age, income, marital status, race/ethnicity, and education. Behavioral data included physical activity (metabolic equivalent hours per week for vigorous or moderate muscle strengthening, walking/biking, and house/yard work), and poor diet (refined grains, red meat, added sugars, solid fats, and high-fat dairy). Structural-equation modeling was performed to examine the interrelationships among these variables with family history of diabetes, high blood pressure, BMI, large waist (waist circumference: women, ≥ 35 inches; men, ≥ 40 inches), triglycerides ≥ 200 mg/dL, and total and HDL (≥ 60 mg/dL) cholesterol. RESULTS After dropping BMI and total cholesterol, our best-fit model included three single factors: socioeconomic position (SEP), physical activity, and poor diet. Large waist had the strongest direct effect on prediabetes (0.279), followed by male sex (0.270), SEP (-0.157), high blood pressure (0.122), family history of diabetes (0.070), and age (0.033). Physical activity had direct effects on HDL (0.137), triglycerides (-0.136), high blood pressure (-0.132), and large waist (-0.067); poor diet had direct effects on large waist (0.146) and triglycerides (0.148). CONCLUSIONS Our results confirmed that, while including factors known to be associated with high risk of developing prediabetes, large waist circumference had the strongest direct effect. The direct effect of SEP on prediabetes suggests mediation by some unmeasured factor(s).
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Affiliation(s)
- Barbara H Bardenheier
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Bardenheier BH, Elixhauser A, Imperatore G, Devlin HM, Kuklina EV, Geiss LS, Correa A. Variation in prevalence of gestational diabetes mellitus among hospital discharges for obstetric delivery across 23 states in the United States. Diabetes Care 2013; 36:1209-14. [PMID: 23248195 PMCID: PMC3631849 DOI: 10.2337/dc12-0901] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine variability in diagnosed gestational diabetes mellitus (GDM) prevalence at delivery by race/ethnicity and state. RESEARCH DESIGN AND METHODS We used data from the Healthcare Cost and Utilization Project State Inpatient Databases for 23 states of the United States with available race/ethnicity data for 2008 to examine age-adjusted and race-adjusted rates of GDM by state. We used multilevel analysis to examine factors that explain the variability in GDM between states. RESULTS Age-adjusted and race-adjusted GDM rates (per 100 deliveries) varied widely between states, ranging from 3.47 in Utah to 7.15 in Rhode Island. Eighty-six percent of the variability in GDM between states was explained as follows: 14.7% by age; 11.8% by race/ethnicity; 5.9% by insurance; and 2.9% by interaction between race/ethnicity and insurance at the individual level; 17.6% by hospital level factors; 27.4% by the proportion of obese women in the state; 4.3% by the proportion of Hispanic women aged 15-44 years in the state; and 1.5% by the proportion of white non-Hispanic women aged 15-44 years in the state. CONCLUSIONS Our results suggest that GDM rates differ by state, with this variation attributable to differences in obesity at the population level (or "at the state level"), age, race/ethnicity, hospital, and insurance.
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Affiliation(s)
- Barbara H Bardenheier
- National Center for Chronic Disease Prevention and HealthPromotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Bardenheier BH, Shefer AM, Rodewald L, Ahmed F, Gravenstein S, Remsburg RE. In Reply: Influenza Vaccination in Long-Term Care Facilities: More Than Standing Order Programs? J Am Med Dir Assoc 2011. [DOI: 10.1016/j.jamda.2011.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bardenheier BH, Shefer AM, Lu PJ, Remsburg RE, Marsteller JA. Are standing order programs associated with influenza vaccination? - NNHS, 2004. J Am Med Dir Assoc 2010; 11:654-61. [PMID: 21030000 DOI: 10.1016/j.jamda.2009.12.091] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 12/30/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND Influenza vaccination coverage among nursing home residents has consistently been reported well below the Healthy People goals. We sought to determine if standing order programs (SOPs) in long-term care facilities are associated with greater influenza vaccination coverage among residents. METHODS The National Nursing Home Survey (2004) is cross-sectional. A total of 1152 US long-term care facilities were systematically sampled with probability proportional to number of beds. A total of 11,939 people aged 65 years or older residing in sampled long-term care facilities between August and December 2004 were randomly sampled. Influenza vaccination coverage of residents was obtained from facility records. Facility's immunization program included standing orders versus other (preprinted admission order, advance physician order, personal physician order, and no program). Multinomial logistic regression was used to examine the relationship between type of influenza immunization program and receipt of vaccination, adjusted for resident and facility confounders. RESULTS The proportion of residents aged 65 years or older who received influenza vaccination was 64%; 41% of residents lived in a facility with an SOP. Influenza vaccination coverage among residents residing in facilities with standing orders was 68% compared with 59% to 63% of residents in facilities with other program types. Logistic regression showed that standing order programs were independently associated with greater influenza vaccination coverage (66.7% versus 62.0%, P < .01). CONCLUSION This study indicates that residents in long-term care facilities having standing order programs for influenza were more likely to be immunized. More research needs to be done to understand how to facilitate adoption of these programs.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Bardenheier BH, Wortley P, Ahmed F, Hales C, Shefer A. Influenza immunization coverage among residents of long-term care facilities certified by CMS, 2005-2006: the newest MDs quality indicator. J Am Med Dir Assoc 2009; 11:59-69. [PMID: 20129216 DOI: 10.1016/j.jamda.2009.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 09/17/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND In October 2005, the Centers for Medicare and Medicaid Services (CMS) required that long-term care (LTC) facilities certified by CMS offer each resident annual influenza vaccination. Subsequently, vaccination status was added to resident assessments collected beginning in the influenza season, 2005-2006. This is the first year immunization coverage can be reported based on a census of LTC residents. OBJECTIVES Report influenza immunization coverage for LTC residents by state, resident, and facility characteristics. Identify uses of the data and areas in need of improvement. METHODS Analysis of CMS' Minimum Data Set of 1,851,676 residents in nursing homes from October 1 through December 31 but who could have been discharged between January 1 and March 31 merged with data for 14,493 non-hospital-based facilities from the Online Survey and Certification Assessment Reporting System. RESULTS Overall, 83% of residents were offered the vaccine and 72% had received the vaccine. Almost 10% refused to receive the vaccine, 14% were not offered the vaccine, 1% were ineligible, and 3% were missing vaccination status. Vaccination coverage varied significantly among states (range: 49% to 87%). Fewer African Americans and Hispanics than whites were offered the vaccine (79% and 79% versus 84%, respectively) and received it (65% and 66% versus 73%, respectively); more African Americans refused the vaccine (12%) than residents of other races and/or ethnicities. Residents of Medicaid-certified-only facilities had higher levels of vaccination than residents of other facilities (82% versus < or =73%). CONCLUSION MDS immunization data can be used as surveillance to work with states to improve coverage. Further research to examine racial disparities in vaccination among LTC residents is needed.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Bardenheier BH, Wortley PM, Shefer A. Influenza Vaccine in African-American and White Nursing Home Residents: Is There a Gap? J Am Geriatr Soc 2009; 57:2164-5. [DOI: 10.1111/j.1532-5415.2009.02535.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gordon NP, Wortley PM, Singleton JA, Lin TY, Bardenheier BH. Race/ethnicity and validity of self-reported pneumococcal vaccination. BMC Public Health 2008; 8:227. [PMID: 18598363 PMCID: PMC2474865 DOI: 10.1186/1471-2458-8-227] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 07/03/2008] [Indexed: 11/17/2022] Open
Abstract
Background National and state surveys show large disparities in pneumococcal vaccination status among Whites, Blacks and Latinos aged ≥ 65. The purpose of this study is to determine whether there is any difference in the validity of self-report for pneumococcal vaccination by race/ethnicity that might contribute to the substantial disparities observed in population-level coverage estimates. Methods Self-reported vaccination status was compared with medical record documentation for samples of White, Black, and Latino members of a large health plan to examine whether differences in validity of self-report contribute to observed disparities. Results Sensitivity was significantly lower for Blacks (0.849, 95% CI 0.818–0.876) and Latinos (0.869, 95% CI 0.847–0.889) than for Whites (0.931 95% CI 0.918–0.942). Specificity was somewhat higher for Blacks than for Latinos and Whites, but the differences were not statistically significant. Coverage for Whites, Blacks and Latinos, respectively, was 84.3%, 73.5%, and 82.3% based on self-report, but 74.8%, 71.9%, and 84.2% based on medical records. Conclusion The results of this study suggest that differential self-report error, i.e., summative effect of over-reporting and under-reporting within a race-ethnic group, may contribute to the size and direction of race-ethnic disparities in pneumococcal vaccination observed in surveys.
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Affiliation(s)
- Nancy P Gordon
- Kaiser Permanente Division of Research, Oakland, CA, USA.
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Lorick SA, Wortley PM, Lindley MC, Bardenheier BH, Euler GL. U.S. Healthcare personnel and influenza vaccination during the 2004-2005 vaccine shortage. Am J Prev Med 2008; 34:455-62. [PMID: 18471580 DOI: 10.1016/j.amepre.2008.01.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 11/30/2007] [Accepted: 01/18/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Healthcare personnel with direct patient contact were prioritized for influenza vaccination during the 2004-2005 vaccine shortage. Data about vaccination coverage among healthcare personnel during vaccine shortages are limited. METHODS Behavioral Risk Factor Surveillance System 2005 data were analyzed in 2007 for a sample of healthcare facility workers (HCFW) aged 18-64 with (n=3456) and without (n=1153) direct patient contact and non-HCFWs (n=39,405). Chi-square tests and logistic regression were used to identify factors associated with influenza vaccination among HCFWs and to compare HCFWs with non-HCFWs with regard to the main reason for nonvaccination during the shortage. RESULTS Vaccination coverage was 37% (SE +/- 3.1) among HCFWs with direct patient contact and 25% (SE +/- 5.7) among those without. In multivariate analysis, coverage was higher among HCFWs who were older, more educated, and with higher incomes and better access to health care. The reason most commonly reported by HCFWs and non-HCFWs for nonvaccination was the belief that they did not need vaccination (35% versus 40%, respectively; p<0.05). CONCLUSIONS Even in a time of influenza-vaccine shortage, when most healthcare personnel were targeted for vaccination, their uptake of the vaccine remained suboptimal. Continued efforts are needed to develop effective interventions to improve the use of influenza vaccination among healthcare workers.
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Affiliation(s)
- Suchita A Lorick
- Epidemic Intelligence Service, Office of Workforce and Career Development, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia 30333, USA.
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Bardenheier BH, Groom H, Zhou F, Kong Y, Shefer AM, Stokley SK, Shih SC. Managed care organizations' performance in delivery of adolescent immunizations, HEDIS, 1999-2002. J Adolesc Health 2008; 42:137-45. [PMID: 18207091 DOI: 10.1016/j.jadohealth.2007.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 08/07/2007] [Accepted: 08/10/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE The Health Plan Employer Data Information Set (HEDIS) provides comparative information across health plans to measure the quality of care and preventive services for health plan beneficiaries. We examined recent trends in adolescent immunizations recommended by the Advisory Committee for Immunization Practices (ACIP) measured through HEDIS and reported to the National Committee for Quality Assurance (NCQA). METHODS The study was based on a longitudinal regression analysis of commercial managed care organizations' HEDIS measures from 1999-2002. HEDIS performance measures and plan characteristics include a sample of approximately 100-400 enrollees per plan each year. The outcome measures were the proportions of enrollees aged 13 years sampled in the plan who received measles-mumps-rubella vaccine (MMR), hepatitis B vaccine, and varicella vaccine. RESULTS The immunization rates for all three antigens increased significantly from 1999 to 2002 (MMR: 57-68%; hepatitis B: 28-51%; and varicella: 21-38%). Factors in the final multivariable models that were found to be significantly associated with increased proportions immunized with MMR vaccine, hepatitis B vaccine, and varicella vaccine include year of report, presence of school entry laws, years in business up to 25 years, and operating in the northeastern U.S. region; the only factor associated with decreasing immunization rates for all antigens was the number of providers per 100 commercial enrollees. CONCLUSIONS Consistent with previous reports, adolescent immunization rates are improving yet remain suboptimal. Strategies to increase immunization rates, as well as to improve documentation of immunization status, among commercial health insurance plans need to be developed and implemented.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Bardenheier BH, Strikas R, Kempe A, Stokley S, Ellis J. Influenza vaccine supply, 2005-2006: did we come up short? BMC Health Serv Res 2007; 7:66. [PMID: 17480227 PMCID: PMC1871587 DOI: 10.1186/1472-6963-7-66] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 05/04/2007] [Indexed: 12/03/2022] Open
Abstract
Background Although total influenza vaccine doses available in the 2005/2006 influenza season were over 80 million, CDC received many reports of delayed and diminished vaccine shipments in October to November of 2005. To better understand the supply problems, CDC and partners surveyed several health care professional groups. Methods Surveys were sent to representative samples of influenza vaccine providers including pediatricians, internists, federally qualified health centers, visiting nurse organizations, and all 64 state and other health departments receiving federal immunization funds directly. In November and December, 2005, providers were asked questions about their experience in ordering influenza vaccine, sources where orders were placed, proportion of orders received, and referral of patients to other vaccination sites. Results The number of providers surveyed (median: 154; range: 64 – 308) and response rates (median: 62%; range: 51% – 77%) varied among groups. Less than half of the providers in most groups placed a single order that was accepted (median: 31%; range: 8% – 53%), and most placed multiple orders. Only 57% of federally qualified health centers and 60% of internists reported they received at least 40% of their orders by the middle of December; the other provider groups received a greater proportion of their orders. Most internists (80%) and federally qualified health centers (54%) reported that they had referred priority group patients to other locations to receive the influenza vaccine due to inadequate supplies. Vaccine providers who ordered only from Chiron received a lower proportion of their orders than providers that ordered from another source or ordered from multiple sources. Conclusion Most of the providers surveyed received only part of their orders by the middle of December. Disruptions in receipt of influenza vaccine during the fall of 2005 were due primarily to shortfalls in vaccine from Chiron and also due to delays and partial shipments from other distributors.
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Affiliation(s)
- Barbara H Bardenheier
- National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Raymond Strikas
- National Vaccine Program Office, Department of Health and Human Services, Washington, D.C., USA
| | - Allison Kempe
- Department of Pediatrics, University of Colorado at Denver and Health Sciences Center and the Children's Outcomes Research Center, The Children's Hospital, Denver, Colorado, USA
| | - Shannon Stokley
- National Center for Immunization and Respiratory Diseases, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jean Ellis
- Member Services and Business Development, Visiting Nurse Associations of America (VNAA), Boston, Massachusetts, USA
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Bardenheier BH, Wortley PM, Winston CA, Washington ML, Lindley MC, Sapsis K. Do patterns of knowledge and attitudes exist among unvaccinated seniors? Am J Health Behav 2007; 30:675-83. [PMID: 17096624 DOI: 10.5555/ajhb.2006.30.6.675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVE To examine patterns of knowledge and attitudes among adults aged > 65 years unvaccinated for influenza. METHODS Surveyed Medicare beneficiaries in 5 areas; clustered unvaccinated seniors by their immunization related knowledge and attitudes. RESULTS Identified 4 clusters: Potentials (45%) would receive influenza vaccine to prevent disease; Fearful Uninformeds (9%) were unsure if influenza vaccine causes illness; Doubters (27%) were unsure if vaccine is efficacious; Misinformeds (19%) believed influenza vaccine causes illness. More Potentials (75%) and Misinformeds (70%) ever received influenza vaccine than did Fearful Uninformeds (18%) and Doubters (29%). CONCLUSION Findings suggest that cluster analyses may be useful in identifying groups for targeted health messages.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-52, Atlanta, GA, USA.
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Bardenheier BH, Wortley PM, Winston CA, Washington ML, Lindley MC, Sapsis K. Do Patterns of Knowledge and Attitudes Exist Among Unvaccinated Seniors? Am J Health Behav 2006. [DOI: 10.5993/ajhb.30.6.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lindley MC, Wortley PM, Winston CA, Bardenheier BH. The role of attitudes in understanding disparities in adult influenza vaccination. Am J Prev Med 2006; 31:281-5. [PMID: 16979451 DOI: 10.1016/j.amepre.2006.06.025] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2006] [Revised: 04/21/2006] [Accepted: 06/02/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Racial/ethnic disparities in influenza vaccine coverage of adults aged 65 years and older persist even after controlling for access, healthcare utilization, and socioeconomic status. Differences in attitudes toward vaccination may help explain these disparities. The purpose of this study was to describe patient characteristics and attitudes toward influenza vaccination among whites and African Americans aged 65 years and older, and to examine their effect on racial disparities in vaccination coverage. METHODS A cross-sectional telephone survey of Medicare beneficiaries in five U.S. sites, sampled on race/ethnicity and ZIP code. Multivariate analysis controlling for demographics, healthcare utilization, and attitudes toward influenza vaccination was conducted in 2005 to assess racial disparities in vaccine coverage during the 2003-2004 season. RESULTS The analysis included 1859 white and 1685 African-American respondents; 79% of whites versus 50% of African Americans reported influenza vaccination in the past year (p < 0.00001). Both vaccinated and unvaccinated African Americans were significantly less likely than whites to report positive attitudes toward influenza vaccination. Even among respondents with provider recommendations, respondents with positive attitudes were more likely to be vaccinated than those with negative attitudes. After multivariate adjustment, African Americans had significantly lower odds of influenza vaccination than whites (odds ratio = 0.55, 95% confidence interval = 0.42-0.72). CONCLUSIONS A significant gap in vaccination coverage between African Americans and whites persisted even after controlling for specific respondent attitudes. Future research should focus on other factors such as vaccine-seeking behavior.
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Affiliation(s)
- Megan C Lindley
- Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Bardenheier BH, Shefer A, Barker L, Winston CA, Sionean CK. Public health application comparing multilevel analysis with logistic regression: immunization coverage among long-term care facility residents. Ann Epidemiol 2006; 15:749-55. [PMID: 15922626 DOI: 10.1016/j.annepidem.2005.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 03/01/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE Public health studies often sample populations using nested sampling plans. When the variance of the residual errors is correlated between individual observations as a result of these nested structures, traditional logistic regression is inappropriate. We used nested nursing home patient data to show that one-level logistic regression and hierarchical multilevel regression can yield different results. METHODS We performed logistic and multilevel regression to determine nursing home resident characteristics associated with receiving pneumococcal immunizations. Nursing home characteristics such as type of ownership, immunization program type, and certification were collected from a sample of 249 nursing homes in 14 selected states. Nursing home resident data including demographics, receipt of immunizations, cognitive patterns, and physical functioning were collected on 100 randomly selected residents from each facility. RESULTS Factors associated with receipt of pneumococcal vaccination using logistic regression were similar to those found using multilevel regression model with some exceptions. Predictors using logistic regression that were not significant using multilevel regression included race, speech problems, infections, renal failure, legal responsibility for oneself, and affiliation with a chain. Unstable health conditions were significant only in the multilevel model. CONCLUSIONS When correlation of resident outcomes within nursing home facilities was not considered, statistically significant associations were likely due to residual correlation effects. To control the probability of type I error, epidemiologists evaluating public health data on nested populations should use methods that account for correlation among observations.
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Affiliation(s)
- Barbara H Bardenheier
- Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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