Update: Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population, 2012-2015


This policy brief is an update of an initial report assessing rural/urban disparities in pneumococcal vaccine service delivery among the fee-for-service (FFS) Medicare population. Our previous report evaluated overall pneumococcal vaccination service delivery in the year 2014, without assessing the contribution of the individual pneumococcal vaccines (PCV13 and PPSV23). In this study we evaluate trends in pneumococcal vaccination service delivery for the years 2012 through 2015, specifically assessing uptake of the PCV13 in 2015, the first full year following the revised vaccination recommendations in September 2014. We also determine the relative contribution of community pharmacies as an alternate site vaccine service provider to PCV13 uptake in rural communities.

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

The number and rate of pneumococcal vaccination services delivered by FFS Medicare providers to eligible beneficiaries (both rural and urban) increased annually between 2012 and 2015. In 2015, pneumococcal vaccine services were delivered by providers to approximately 5,353,000 FFS beneficiaries representing 16% of the FFS population nationwide, a 380% increase over that reported in 2014. We estimate that 92% of those vaccines administered in 2015 to FFS beneficiaries were PCV13. Consistent with our previous findings, there were continued disparities in pneumococcal vaccine service delivery between rural and urban communities with an estimated 10.7% of FFS beneficiaries receiving pneumococcal vaccination services in rural communities compared to 17.4% in urban communities, a 63% higher vaccination rate in urban communities.

Primary care providers delivered the majority (72.2%) of pneumococcal vaccination services to FFS Medicare beneficiaries in 2015, while pharmacy providers accounted for one-fourth. The proportion of pneumococcal vaccines delivered by pharmacists in rural areas increased from 19.9% in 2012 to 33.5% in 2015 but only modestly increased in urban areas (20.4% to 22.6%). 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
Joseph Vanghelof, Aric Schadler, Patricia Freeman, Jeffery Talbert