35 - Pneumococcal Vaccination in High-Risk Adults: An Initial Analysis Incorporating Social Determinants of Health

Background: Despite CDC’s recommendation, vaccination rates for adults at high-risk of invasive pneumococcal disease are below HealthyPeople 2020 goals. Comparatively little is known about influencers on vaccine-seeking behavior in this population, particularly related to social determinants of health. To address this gap, this study assessed the potential influence of select social determinants on uptake of and time to pneumococcal vaccination among a high-risk, insured US population.

Methods: Using the MarketScan commercial claims databases between 2013-2016, adult patients (aged 18-64 years) were followed from their first diagnosis for a condition deeming them high-risk for invasive pneumococcal disease through one year following the diagnosis and observed for pneumococcal vaccination in outpatient clinics and pharmacies. Publicly-available data on select social determinants of health were incorporated into analyses, guided by the WHO vaccine hesitancy matrix. Logistic regression determined predictors of vaccination and a generalized linear model compared days to being vaccinated while controlling for baseline demographic and clinical characteristics.

Results: A total of 173,712 patients were analyzed of which 25.3% were vaccinated against invasive pneumococcal disease within the first year of being deemed high risk, nearly all of which (98.5%) were received in outpatient clinics. The odds of vaccination were higher in urban areas (OR: 1.18; 95% CI: 1.144-1.223), areas of higher health literacy (OR: 1.02; 95% CI: 1.019-1.025), and more liberal-voting communities (OR: 1.5; 95% CI: 1.23-1.88). Conversely, the odds of vaccination were particularly low in areas of higher poverty (OR: 0.14; 95% CI: 0.068-0.304) and with more limited Internet access (OR: 0.14; 95% CI: 0.062-0.305) as well as among adults who did not also get a seasonal influenza vaccine (OR: 0.05; 95% CI: 0.048-0.052). Time to vaccination was longer in rural areas (B=8.3, p< 0.0001) and communities with less Internet access (B=75.6, p< 0.001).

Conclusion: Results suggest that some social determinants may be influencing pneumococcal vaccine-seeking behavior among those deemed high-risk. A more formal framework must be assessed to determine the full impact of these factors across vaccines recommended in adults.