title: Brief report: risk factors for pneumococcal vaccine refusal in adults: a casecontrol study.
abstract: BACKGROUND
  Invasive pneumococcal disease is a significant cause of morbidity and mortality in the United States. Despite availability of an effective vaccine, many patients refuse vaccination.
  
  
  OBJECTIVE
  To investigate patient characteristics and features of the patient-provider relationship associated with pneumococcal vaccine refusal.
  
  
  METHODS
  Case-control study using chart review.
  
  
  METHODS
  Five hundred adults from the medical clinics of a 1,000-bed inner-city teaching hospital.
  
  
  RESULTS
  Independent risk factors for pneumococcal vaccine refusal included patient-provider gender discordance (odds ratio (OR)=2.09, 95% confidence interval (CI) 1.07 to 4.09); a visit to a not-usual provider at the time of vaccine offering (OR=2.26, 95% CI 1.13 to 4.49); never having received influenza vaccination (OR=7.44, 95% CI 3.76 to 14.76); prior pneumococcal vaccine refusals (OR=3.45, 95% CI 1.60 to 7.43); and a history of ever having refused health maintenance tests (OR=2.86, 95% CI 1.40 to 5.84).
  
  
  CONCLUSIONS
  We have identified both patient factors and factors related to the patient-provider relationship that are risk factors for pneumococcal vaccine refusal. By identifying patients at risk for pneumococcal vaccine refusal, efforts to increase vaccination rates can be better targeted.
authors.affiliation: Division of General Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. esley.miller@emory.edu
authors.forename: Lesley S
authors.initials: LS
authors.lastname: Miller
authors.forename: Ekaterina V
authors.initials: EV
authors.lastname: Kourbatova
authors.forename: Sandy
authors.initials: S
authors.lastname: Goodman
authors.forename: Susan M
authors.initials: SM
authors.lastname: Ray
mesh_terms: D000368:Aged; D001294:Attitude to Health; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D010817:Physician-Patient Relations; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012189:Retrospective Studies; D012307:Risk Factors; D016312:Treatment Refusal
chemical_list: D022242:Pneumococcal Vaccines