Association of influenza vaccine uptake with health, access to health care, and medical mistreatment among adults from low-income neighborhoods in New Haven, CT: a classification tree analysis.
OBJECTIVE
The aim of this study is to identify population subgroups under-vaccinated for influenza through classification tree analysis to inform interventions aimed at improving future vaccine uptake.


METHODS
A cross-sectional community health needs assessment was conducted from 09/2012 through 11/2012 among randomly selected households in six low-income neighborhoods in New Haven, CT (N=1300 adults, aged 18-65). Known correlates of influenza vaccine uptake plus experience of medical mistreatment were used to develop a classification tree to identify under-vaccinated population subgroups


RESULTS
Forty-five percent of respondents reported receiving the influenza vaccine. The classification tree identified healthy adults and uninsured adults at increased risk of influenza complications as subgroups with low vaccine uptake (40% and 30%, respectively). The subgroup representing insured, high-risk adults who reported experience of medical mistreatment had moderate vaccine uptake (45%). Sensitivity of the classification tree was high (83%, 95% CI=80% to 86%), indicating a strong true positive rate using these subgroups.


CONCLUSIONS
Results highlight the need for renewed attention to promoting the influenza vaccination recommendation for all adults, particularly among healthy adults, uninsured, high-risk adults and insured, high-risk adults who have experienced medical mistreatment. Further research is needed to better understand how to reach these population subgroups.
Community Alliance for Research and Engagement, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA. Electronic address: kathryn.gilstad-hayden@yale.edu.
Kathryn
K
Gilstad-Hayden
New Haven Health Department, 54 Meadow Street, New Haven, CT 06519, USA; Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College Street, New Haven, CT 06520, USA. Electronic address: amanda.durante@yale.edu.
Amanda
A
Durante
Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, BCH3201, Attn: Valerie Earnshaw, Boston, MA 02115, USA; Harvard Medical School, Department of Pediatrics, USA. Electronic address: Valerie.Earnshaw@childrens.harvard.edu.
Valerie A
VA
Earnshaw
Pace University, Psychology Department, 41 Park Row, 13th Floor, Room 1317, New York, NY 10038, USA. Electronic address: lrosenthal@pace.edu.
Lisa
L
Rosenthal
Community Alliance for Research and Engagement, Yale School of Public Health, 135 College Street, Suite 200, New Haven, CT 06510, USA. Electronic address: jeannette.ickovics@yale.edu.
Jeannette R
JR
Ickovics
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D015992:Body Mass Index; D003237:Connecticut; D003430:Cross-Sectional Studies; D003663:Decision Trees; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006304:Health Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011204:Poverty Areas; D011369:Professional-Patient Relations; D017678:Sex Distribution; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
D007252:Influenza Vaccines
Classification tree analysis; Influenza; Uptake; Vaccine