Rates of pneumococcal vaccination in adults with asthma fall short of national goals, according to a new study.
Researchers used data from the 2012-2013 Behavioral Risk Factor Surveillance System Asthma Call-back Survey in 29 states to examine rates of pneumococcal vaccination in adults who were 18 to 64 years of age, had ever been employed, and had work-related or non-work-related asthma. Asthma and pneumococcal vaccination were determined by self-report; adults were considered to have work-related asthma if they reported ever receiving such a diagnosis from a physician or other health care professional. The researchers used multiple logistic regression to calculate adjusted prevalence ratios and 95% CIs. Study results were published online Sept. 27 by the American Journal of Preventive Medicine.
Approximately 9,923 ever-employed adults with asthma responded to the survey and were included in the analysis. Overall, 70.2% were women, 76.7% were white, and 68.8% were 45 to 64 years of age. A total of 42.0% of the study sample reported ever receiving a pneumococcal vaccine. Rates were below this threshold in those ages 18 to 44 years (32.7%), men (39.0%), those with a college degree (36.7%), those with a household income of $50,000 or more (36.3%), those who were employed in the past year (37.2%), those who had never smoked (38.9%), those who had well-controlled asthma (35.2%), and those who had not had a routine checkup for asthma in the past 12 months (33.7%).
Vaccination rates were higher among the 15.2% of patients who were estimated to have current work-related asthma than those whose asthma was not work-related (53.7% vs. 35.0%; adjusted prevalence ratio, 1.24; 95% CI, 1.06 to 1.45). In the work-related asthma group, rates of pneumococcal vaccination were lowest among those who were Hispanic and those who did not have health insurance (36.2% and 38.5%, respectively). Those in the work-related asthma group who were 45 to 64 years of age, had not been employed in the past year, had health insurance, had used an inhaled corticosteroid in the previous three months, had received the influenza vaccine, and had poorly controlled asthma were more likely to have received the pneumococcal vaccine.
An estimated 40.8% of patients had current asthma that was possibly work-related, that is, they had not been told by a physician or other health care professional that they had work-related asthma but reported that environmental conditions at their job first caused their asthma or made their symptoms worse. In this group, 44.7% reported ever receiving a pneumococcal vaccine (adjusted prevalence ratio vs. patients with non-work-related asthma, 1.15; 95% CI, 1.01 to 1.31). In this group, pneumococcal vaccination was least likely among patients who could not see a subspecialist for their asthma, those who had been employed in the past year, and those who had no other chronic diseases.
The authors noted that their study was limited by self-report, included data from only 29 states, and did not include information on type or timing of pneumococcal vaccine. However, they pointed out that the federal initiative Healthy People 2020 has a goal of 60% coverage for pneumococcal vaccine in high-risk adults, which includes adults with asthma, and that the rates found in this study were for the most part suboptimal, with the exception of certain subgroups.
“Public health and clinical efforts should continue to focus strategies on meeting or exceeding the Healthy People 2020 pneumococcal vaccination goal among adults with [work-related asthma], particularly those at high risk, such as patients taking inhaled corticosteroids, with other chronic conditions, or with poorly controlled asthma,” the authors wrote. “Moreover, healthcare providers should verify pneumococcal vaccination status in their patients with asthma and offer the vaccine to those not vaccinated.”