Barriers and Disparities Associated with Pneumococcal Immunization Among Rural Elderly Adults

Research center:
Lead researcher:
Project funded:
September 2016
Project completed:
January 2018

Community-acquired pneumonia (CAP) poses a considerable threat to the health of older adults, with the incidence of CAP increasing dramatically among those aged 65 years old and older. Mortality for invasive pneumococcal disease (IPD) also increases with age, doubling from age 65 (20%) to age 85 (40%). Streptococcus pneumonia (pneumococcus) is a leading infectious cause of illness, including bacteremia, meningitis, and pneumonia, accounting for up to 50% of all cases. Use of a 7-valent pneumococcal conjugate vaccine (PCV7) and, more recently, PCV13 among children has reduced pneumococcal infections among children and indirectly among adults. In August 2014, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of 13-valent pneumococcal conjugate vaccine (PCV13, Prevnar 13) for all adults aged 65 years old and older, regardless of prior vaccine use. National estimates show that only 20% of eligible adults are currently vaccinated, and prior research on barriers to immunization find that rural elderly minorities are significantly less likely to receive immunizations. The new 2014 ACIP recommendation for all adults aged 65 and older to receive the new PCV13 (after November 2014) represents a unique opportunity for our research team to observe the characteristics associated with receipt of the vaccine and to identify disparities and barriers to adults receiving pneumococcal vaccine.

To conduct this study, we employed a multi-data approach using self-reported survey data from the CDC as well as large-scale retrospective administrative health outcomes data licensed to the UK Center for Clinical and Translational Science's Enterprise Data Trust (EDT). The EDT is collection of health data from patient care operations, administrative financial systems, and multiple research projects organized into a semantically integrated data warehouse to support translational research. For this study, we used two datasets from the EDT: the Humana health insurance data that covers 12 million members each year and the Truven MarketScan health insurance database that covers about 60 million members each year. Both are large-scale, nationally representative health care experience data sets that contain administrative records for inpatient, outpatient, professional physician services, and pharmaceuticals as well as member demographics and provider information. To supplement the findings from the retrospective experience data, we used the BRFSS data, a nationally representative telephone survey conducted by the CDC.