title: Uptake of Influenza Vaccination and Missed Opportunities Among Adults with High-Risk Conditions, United States, 2013.
abstract: Since 1960, the Advisory Committee on Immunization Practices has recommended influenza vaccination for adults with certain high-risk conditions because of increased risk for complications from influenza infection. We assessed national influenza vaccination among persons ages 18-64 years with high-risk conditions.
  
  
  
  We analyzed data from the 2012 and 2013 National Health Interview Survey. The Kaplan-Meier survival analysis procedure was used to estimate the cumulative proportion of influenza vaccination among adults ages 18-64 years with high-risk conditions. Potential missed opportunities for influenza vaccination were also evaluated. Multivariable logistic regression and predictive marginal analyses were conducted to identify factors independently associated with vaccination.
  
  
  
  Overall, 39.9 million adults ages 18-64 years (18.9%) had at least one high-risk condition. For adults ages 18-64 years with high-risk conditions, overall influenza vaccination coverage was 49.5%. Coverage among adults 50-64 years of age was significantly higher compared with those ages 18-49 years (59.3% vs 39.0%; P <.05). Among adults ages 18-64 years, coverage was 46.2% for those with chronic lung diseases, 50.5% for those with heart disease, 58.0% for those with diabetes, 62.5% for those with renal disease, and 56.4% for those with cancer. Overall, 90.1% reported at least one visit to a health care setting where vaccination could have been provided. Among adults ages 18-64 years with high-risk conditions, older age, being female, Hispanic ethnicity or Asian race, having one or more physician visits, a regular physician for health care, health insurance, and having ever received pneumococcal vaccination were independently associated with a higher likelihood of influenza vaccination. Being widowed/divorced/separated or never married and not being employed were independently associated with a lower likelihood of influenza vaccination.
  
  
  
  Influenza vaccination coverage varies substantially by age and high-risk conditions but remains low. Approximately 50% of those with high-risk conditions remain unvaccinated. Health care providers should ensure they routinely assess influenza vaccination status, and recommend and offer vaccines to those with high-risk conditions.
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Ga. 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, Centers for Disease Control and Prevention (CDC), Atlanta, Ga; Leidos Inc, Atlanta, Ga.
authors.forename: Alissa
authors.initials: A
authors.lastname: O'Halloran
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Ga; Eagle Medical Services LLC, San Antonio, Tex.
authors.forename: Helen
authors.initials: H
authors.lastname: Ding
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Ga; Leidos Inc, Atlanta, Ga.
authors.forename: Anup
authors.initials: A
authors.lastname: Srivastav
authors.affiliation: Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Ga.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Williams
mesh_terms: D000328:Adult; D017677:Age Distribution; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage* / Q000592:standards; D007251:Influenza, Human / Q000150:complications* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Adults; Coverage; High-risk conditions; Influenza vaccine; Vaccination