Influenza Vaccination Among Asthmatic Patients During the

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Influenza Vaccination Among Asthmatic Patients
Duringthe Flu Season

• Jalal Zuberi, Nabila Haque, Mary Hixson,
• Sonja Hutchins

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Background

• Asthma a substantial health problem
• 15 million Americans
• 5 million lt18 years
• Advisory groups recommend influenza
• vaccine for asthmatic patients
• High national health objectives for 2010
• (60-90)

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Influenza Vaccine Coverage in Asthmatic Patients
Author(Year) Study Design Population Coverage
Kramarz (1995-1997) Cohort 68,839 lt18 yrs 9-10
Chung (1998) Cross-sectional 117 6-48 mos 25
Rangel (1998) Cross-sectional 2,000 18-64 yrs gt65yrs 32 63
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Influenza Vaccine Safetyin Asthmatic Patients
Author(Year) Study Design Population Difference
ALA (2000) RCT 2032 1-6 yrs 1.1 NS
Kramarz (1993-1996) Cohort 70,753 lt18 yrs 0.65-0.78
Cates (lt2000) 5 RT Variable Variable
Nicholson (1998) RCT 262 18-75 yrs NS
IRR
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Objectives

• Assess influenza vaccine coverage among asthmatic
  patients in an academic medical practice
• Identify factors that predict influenza
  vaccination

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MethodsStudy Design

• Retrospective cohort study
• 1997-1998 influenza season
• Medical record review, 1999-2000
• Information from record
• Date of birth Insurance
• Gender Asthma severity
• Race/ethnicity Influenza vaccine

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Methods-Study Population

• Computerized billing list of patients with ICD- 9
  code 493 for asthma
• Visit between September 1, 1997
• April 30, 1998
• No other chronic diseases
• No allergic reactions to vaccination

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MethodsAsthma Severity

• Symptoms Nocturnal PEF
• Mild gt1/week, gt2/month gt80
• lt1/day
• Moderate Daily gt1/week 60-80
• Severe Continual Frequent lt60

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Study Population-Age DistributionN216
Age (Years) Number Percent
lt5 37 17
5-17 71 33
18-64 93 43
gt65 14 7
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Study Population Gender and and Race/Ethnicity
Gender Number Percent()
Female 126 59
Male 88 41
Race/Ethnicity
African American 78 96
White American 2 4
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Study Population--Insurance Status
Insurance Number Percent
Private 124 57
Public 81 38
Other(Military) 1 0.5
None 10 5
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Study PopulationAsthma Severity
Age (Years) Number Percent
Mild 54 26
Mild-Moderate 20 10
Moderate 32 16
Moderate-Severe 24 12
Severe 22 11
Unclassified 54 26
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Influenza Vaccine Coverage of Asthma Patients in
1997-1998 and 2010 National Health Objectives
(N216)
90
60
31
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Influenza Vaccine Coverage in Asthma Patients By
Age Group, 1997-1998
National Health Objective (gt65yrs), 2000
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Predictors of Influenza Vaccination
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Predictor of Influenza Vaccination in Asthma
Patients-Age
Age Total Vaccinated RR (95CI)
lt17 yrs 108 12 Reference
gt18 yrs 107 49 4.0(2.3-7.0)
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Predictor of Influenza Vaccination in Asthma
Patients-Gender
Gender Total Vaccinated RR (95CI)
Female 126 36 1.5(1.0-2.3)
Male 88 24 Reference
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Predictor of Influenza Vaccination in Asthma
Patients-Race/Ethnicity
Ethnicity Total Vaccinated RR (95CI)
African American 78 32 Reference
White American 2 100 3.1(2.3-4.3)
Fishers Exact, P0.11
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Predictor of Influenza Vaccination in Asthma
Patients-Insurance Status
Insurance Total Vaccinated RR(95CI)
Private 124 23 Undefined
Public 81 46 Undefined
None/Other 11 0 Reference
Fishers Exact P lt0.01 and P0.12
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Predictor of Influenza Vaccination in Asthma
Patients--Severity of Asthma
13.1
5.6
4.5
1.0
0.9
NumberRR Plt0.05
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Preliminary ResultsFollow-Up Study2000-2001
Influenza Season
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Influenza Vaccine Coverage in Asthma Patients By
Season
National Vaccine Shortage
66/216
6/121
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Patient Reported Reasons For Lack of Vaccination
(N113)
Reason Number Percent
Doctor did not advise 73 65
Safety concern 21 16
Vaccine not effective 5 4
Not convenient 5 4
Did not get around to it 4 4
No need for vaccine 2 2
Sick at visit 2 2
Afraid of needles 1 1
Did not know 1 1
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Conclusions

• Suboptimal influenza vaccine coverage
• Coverage improved with age and severity
• of asthma
• Predictors of vaccination
• Adults
• Female
• Insurance
• Moderate/severe asthma

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Conclusion (Continued)

• Substantial drop in vaccine coverage during
  national vaccine shortage
• No doctor advice--most frequent reason for
• lack of vaccination
• Comprehensive follow-up study underway to
• Compare various providers (specialty and county
  hospital outpatient department)
• Use findings as baseline for intervention study
  

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