title: Impact of health insurance status on vaccination coverage among adult populations.
abstract: BACKGROUND
  Underinsurance is a barrier to vaccination among children. Information on vaccination among adults aged ≥18 years by insurance status is limited. This study assesses vaccination coverage among adults aged ≥18 years in the U.S. in 2012 by health insurance status and access to care characteristics.
  
  
  METHODS
  The 2012 National Health Interview Survey data were analyzed in 2014 to estimate vaccination coverage among adults aged ≥18 years by health insurance status for seven routinely recommended vaccines.
  
  
  RESULTS
  Influenza vaccination coverage among adults aged ≥18 years without or with health insurance was 14.4% versus 44.3%, respectively; pneumococcal vaccination coverage among adults aged 18-64 years with high-risk conditions was 9.8% versus 23.0%; tetanus and diphtheria toxoid (Td) coverage (age ≥18 years) was 53.2% versus 64.5%; tetanus, diphtheria, and acellular pertussis (Tdap) coverage (age ≥18 years) was 8.4% versus 15.7%; hepatitis A (HepA) coverage (age 18-49 years) was 16.6% versus 19.8%; hepatitis B (HepB) coverage (age 18-49 years) was 27.5% versus 38.0%; shingles coverage (age ≥60 years) was 6.1% versus 20.8%; and human papillomavirus (HPV) coverage (women aged 18-26 years) was 20.9% versus 39.8%. In addition, vaccination coverage differed by insurance type, whether respondents had a regular physician, and number of physician contacts.
  
  
  CONCLUSIONS
  Overall, vaccination coverage among adults aged ≥18 years is lower among uninsured populations. Implementation of effective strategies is needed to help improve vaccination coverage among adults aged ≥18 years, especially those without health insurance.
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia. Electronic address: lhp8@cdc.gov.
authors.forename: Peng-jun
authors.initials: PJ
authors.lastname: Lu
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
authors.forename: Alissa
authors.initials: A
authors.lastname: O'Halloran
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006801:Humans; D007348:Insurance, Health; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*; D014612:Vaccines; D055815:Young Adult
chemical_list: D014612:Vaccines