Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population


The objective of this study was to identify rural versus urban disparities in pneumococcal vaccine provision in the elderly (age 65 or older) adult population and assess the impact of pharmacy as an alternate site provider in rural communities.

We extracted data from the 2014 Medicare Physician and Other Supplier Public Use File (PUF) and merged it with additional data on Medicare eligibility and characteristics for each county in the U.S. Descriptive statistics were calculated and regression models were used to identify county-level factors associated with receipt of immunization. To identify pneumococcal vaccination, HCPCS code G0009 was used for each provider billing Medicare. The Rural-Urban Continuum Codes (RUCCs) were used to assign counties to rural versus urban designations, with codes 1-3 designated as urban and codes 4-9 designated as rural.

A significant disparity was noted between rural and urban vaccine service delivery with fewer vaccines administered in rural areas. Of the 1,444,829 vaccination services provided in 2014, 207,703 (14.4%) were delivered in rural areas compared to 1,237,126 (85.6%) delivered in urban areas. The overall mean vaccination rate in urban areas was 4.66 compared to a mean vaccination rate of 2.81 in rural areas, indicating a 40% lower mean vaccination rate in rural communities.

In 2014, over two-thirds (72.5%) of pneumococcal vaccine services were delivered to fee-for-service Medicare recipients by primary care providers, while pharmacy providers accounted for almost one-fourth (22.2%) of all pneumococcal vaccine services provided. A significantly greater proportion of pneumococcal vaccine services were delivered by pharmacy providers in rural versus urban counties (29.4% vs. 21.1%; P < .001). In addition to the descriptive results, we calculated multivariate regression models to identify county-level characteristics associated with receipt of pneumococcal vaccine. Our models indicate that pharmacy providers have a significant impact on pneumococcal vaccine delivery in rural areas.

Given the shortage of primary care providers in some rural areas, access to vaccination services may be limited. Engaging community pharmacists who are already embedded in rural communities may help address the need for increasing rural populations' access to health care and improving vaccination rates across all demographic sectors.

Rural and Underserved Health Research Center
Jeffery Talbert, Aric Schadler, Patricia Freeman