StateSpecific Estimates of Influenza Vaccination Among Adults Aged 1864 Years with Asthma, U'S', 200

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State-Specific Estimates of Influenza Vaccination
Among Adults Aged 18-64 Years with Asthma, U.S.,
2001

• James A. Singleton, Peng-Jun Lu
• National Immunization Program
• Centers for Disease Control and Prevention
• 37th National Immunization Conference
• March 17, 2003, Chicago, IL

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Influenza Disease Burden Persons Aged lt65 Years

• Average 3,500 influenza-associated deaths per
  season, 1990/91 - 1998/99
• Average 65,000 influenza-associated
  hospitalizations per season, 1969/70 1994/95
• Hospitalization rates higher for persons with
  certain underlying health conditions (e.g, heart
  or lung disease, diabetes) compared to persons
  without these conditions
• Ages 15-44, 56-110 /100,000 vs. 23-25 /100,000
• Ages 45-64, 392-635 /100,000 vs. 13-23 /100,000

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Recommendations of the Advisory Committee on
Immunization Practices

• Influenza vaccine recommended for
• Persons at increased risk for complications
• aged 65 years and older
• with chronic pulmonary or cardiovascular
  conditions, including asthma
• with other selected diseases (e.g., diabetes,
  renal dysfunction, hemoglobinopathies,
  immunosuppression)
• Pregnant women past 1st trimester during
  influenza season
• Persons aged 50-64 years
• Persons who can transmit to those at increased
  risk
• Health care workers
• Household contacts of persons at increased risk

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Guidelines for the Diagnosis Management of
Asthma
Annual influenza vaccinations are recommended
for patients with persistent asthma.

• July 1997
• National Asthma Education and Prevention Program
• National Heart, Lung and Blood Institute
• National Institutes of Health

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Healthy People 2010

• Objective 14-29c
• Influenza and pneumococcal vaccination of
  non-institutionalized, high-risk adults aged
  18-64 years
• 60 target
• Includes influenza vaccination for persons with
  asthma

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Objective

• Estimate state-specific and national levels of
  self-reported receipt of influenza vaccination
  among adults aged 18-64 years with asthma, using
  the 2001 Behavioral Risk Factor Surveillance
  System (BRFSS) data
• questions on asthma prevalence and influenza
  vaccination both included in the core BRFSS in
  2001 (first time)

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Methods - Data

• BRFSS 2001 Ages 18-64 yrs (N170,412)
• Asthma responded yes to both Have you ever
  been told by a doctor, nurse, or other health
  professional that you had asthma? and Do you
  still have asthma? (N13,327)
• Influenza vaccination responded yes to During
  the past 12 months, have you had a flu shot?
  (excluded DK/NS/refused)

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Methods - Analysis

• National estimates of influenza vaccination
  prevalence
• Stratified by age, combined asthma and diabetes
  status, race/ethnicity, sex, education, and
  health status
• Included Guam, Puerto Rico, and Virgin Islands
• State-specific estimates of influenza vaccination
• Used SUDAAN to calculate point estimates and 95
  confidence intervals (error bars on charts)

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Influenza vaccination by combined asthma and
diabetes status, adults aged 18-64 years,all
reporting areas

• 6.8 reported asthma only, 4.4 diabetes only,
  0.6 both asthma diabetes, and 88.2 neither
• Influenza vaccination prevalence was higher among
  persons with either asthma (31) or diabetes
  (42), or both (51), compared to persons
  reporting neither condition (21)

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Influenza vaccination by age, adults aged 18-64
years with asthma only,all reporting areas

• Among persons with asthma but not diabetes,
  influenza vaccination prevalence was higher for
  those aged 50-64 years (47) than for younger
  adults (26)
• vaccination prevalence did not differ between men
  and women, and did not differ significantly by
  race/ethnicity

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Influenza vaccination by level of education,
adults aged 18-64 years with asthma only,all
reporting areas

• Among persons with asthma but not diabetes,
  influenza vaccination prevalence was higher for
  high school graduates (30) or persons with at
  least some college (32) compared to those with
  less than high school education (25)

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Influenza vaccination by health status, adults
aged 18-64 years with asthma only,all reporting
areas

• Among persons with asthma but not diabetes,
  influenza vaccination prevalence was higher for
  persons reporting poor health (43) compared to
  those with better health (29-31)

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State-specific influenza vaccination
prevalence,by asthma status, adults aged 18-64
years

• Among persons with asthma, influenza vaccination
  prevalence (squares with 95 confidence interval)
  ranged from 43 in Oklahoma to 23 in Wyoming
• Median 33, 75th percentile 36, 25th
  percentile 29
• Influenza vaccination prevalence was higher among
  persons with asthma (squares) compared to persons
  without asthma (bars) in most states.

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Conclusions

• Influenza vaccination prevalence among adults
  aged 18-64 years
• Higher for persons with diabetes vs. asthma
• Higher for persons with asthma vs. without asthma
• Among persons with asthma, higher for
• those aged 50-64
• those with poor reported health
• Among persons with asthma, vaccination levels in
  states were only 1/3 to 2/3 of the Healthy People
  2010 objective of 60

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Limitations

• Persons with high-risk conditions other than
  asthma or diabetes were not ascertained
• Asthma severity was not ascertained
• Reported influenza vaccination status and health
  conditions not validated
• BRFSS response rate gt60 in only 10 of 54
  reporting areas

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Opportunities for Improvement

• Further trend analysis for persons with asthma
  possible for all states since influenza
  vaccination questions included on BRFSS in 2001,
  2002, 2003
• Annual monitoring possible if influenza
  vaccination questions included on BRFSS core in
  2004 beyond
• Further past trend analysis possible for states
  using BRFSS asthma modules prior to 2001

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Opportunities for Improvement

• Collaboration between local/state programs for
  immunization, asthma, other chronic disease
  programs
• Share BRFSS flu vaccination data with coalitions,
  provider groups
• Promote use of NAEPP asthma management guidelines
  ACIP recommendations
• Encourage providers to use evidence-based
  immunization strategies
• Standing orders, patient reminder/recall,
  provider reminder, provider assessment feedback

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http//www.cdc.gov/nceh/airpollution/asthma/contac
ts/default.htm
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