title: Influenza vaccination among children with asthma in medicaid managed care.
abstract: OBJECTIVE
  To describe influenza vaccination rates and identify risk factors for missing vaccination among children with asthma in managed Medicaid.
  
  
  METHODS
  As part of a longitudinal study of asthma care quality, parents of children aged 2-16 years with asthma enrolled in Medicaid managed care organizations in Massachusetts, Washington, and California were surveyed by telephone at baseline and 1 year. We evaluated influenza vaccination rates during the follow-up year.
  
  
  RESULTS
  The study population included 1058 children with asthma. The influenza vaccination rate was 16% among all children with asthma and 21% among those with persistent asthma. Children with persistent asthma (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.36-0.79) and those who had been hospitalized during the follow-up year (OR 0.29, 95% CI 0.11-0.76) were less likely to miss vaccination. Children older than 9 years (OR 1.66, 95% CI 1.13-2.46) and children of parents with less than a high school education (OR 2.29, 95% CI 1.05-5.03), compared with a college degree, were at risk for missing vaccination. Among children with persistent asthma, older children (OR 1.65, 95% CI 1.01-2.69) and children of parents with less than a high school education (OR 4.13, 95% CI 1.43-11.90) were more likely to miss influenza vaccination.
  
  
  CONCLUSIONS
  Our findings suggest that interventions directed toward older children and families with lower educational levels may help improve influenza vaccination rates among this high-risk group. The low overall vaccination rate highlights the need for improvement in this important component of asthma care quality for all children with asthma.
authors.affiliation: Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts, USA. sgnanasekaran@partners.org
authors.forename: Sangeeth K
authors.initials: SK
authors.lastname: Gnanasekaran
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Paula
authors.initials: P
authors.lastname: Lozano
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Farber
authors.forename: Felicia W
authors.initials: FW
authors.lastname: Chi
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Lieu
mesh_terms: D000293:Adolescent; D001249:Asthma; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007252:Influenza Vaccines; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D008329:Managed Care Programs; D008484:Medicaid; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines