scholarly journals 35. Pneumococcal Vaccination in High-Risk Adults: An Initial Analysis Incorporating Social Determinants of Health

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S41-S42
Author(s):  
Justin Gatwood ◽  
Chi-Yang Chiu ◽  
Sohul A Shuvo ◽  
Sujith Ramachandran ◽  
Kenneth Hohmeier ◽  
...  
Keyword(s):  
High Risk ◽  
Social Determinants Of Health ◽  
Invasive Pneumococcal Disease ◽  
Social Determinants ◽  
Pneumococcal Disease ◽  
Pneumococcal Vaccination ◽  
Determinants Of Health ◽  
Outpatient Clinics ◽  
Research Support ◽  
Seeking Behavior

Abstract Background Despite CDC’s recommendation, vaccination rates for adults at high-risk of invasive pneumococcal disease are below HealthyPeople 2020 goals. Comparatively little is known about influencers on vaccine-seeking behavior in this population, particularly related to social determinants of health. To address this gap, this study assessed the potential influence of select social determinants on uptake of and time to pneumococcal vaccination among a high-risk, insured US population. Methods Using the MarketScan commercial claims databases between 2013–2016, adult patients (aged 18–64 years) were followed from their first diagnosis for a condition deeming them high-risk for invasive pneumococcal disease through one year following the diagnosis and observed for pneumococcal vaccination in outpatient clinics and pharmacies. Publicly-available data on select social determinants of health were incorporated into analyses, guided by the WHO vaccine hesitancy matrix. Logistic regression determined predictors of vaccination and a generalized linear model compared days to being vaccinated while controlling for baseline demographic and clinical characteristics. Results A total of 173,712 patients were analyzed of which 25.3% were vaccinated against invasive pneumococcal disease within the first year of being deemed high risk, nearly all of which (98.5%) were received in outpatient clinics. The odds of vaccination were higher in urban areas (OR: 1.18; 95% CI: 1.144–1.223), areas of higher health literacy (OR: 1.02; 95% CI: 1.019–1.025), and more liberal-voting communities (OR: 1.5; 95% CI: 1.23–1.88). Conversely, the odds of vaccination were particularly low in areas of higher poverty (OR: 0.14; 95% CI: 0.068–0.304) and with more limited Internet access (OR: 0.14; 95% CI: 0.062–0.305) as well as among adults who did not also get a seasonal influenza vaccine (OR: 0.05; 95% CI: 0.048–0.052). Time to vaccination was longer in rural areas (B=8.3, p< 0.0001) and communities with less Internet access (B=75.6, p< 0.001). Conclusion Results suggest that some social determinants may be influencing pneumococcal vaccine-seeking behavior among those deemed high-risk. A more formal framework must be assessed to determine the full impact of these factors across vaccines recommended in adults. Disclosures Justin Gatwood, PhD,MPH, AstraZeneca (Grant/Research Support)GlaxoSmithKline (Grant/Research Support)Merck & Co. (Grant/Research Support) Tracy Hagemann, PharmD, GSK (Grant/Research Support)Merck (Grant/Research Support)

Role of social determinants of health in pneumococcal vaccination among high-risk adults

Vaccine ◽  
2021 ◽  
Author(s):  
Justin Gatwood ◽  
Chi-Yang Chiu ◽  
Sohul Shuvo ◽  
Sujith Ramachandran ◽  
Saumil Jadhav ◽  
...  
Keyword(s):  
High Risk ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Pneumococcal Vaccination ◽  
Determinants Of Health

Abstract 262: The Impact of Social Determinants of Health on Heart Failure Readmission in a Veteran Population: A Single Center Study

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Sunita K Mahabir ◽  
Neal Olarte ◽  
Ana M Palacio
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Factors ◽  
Determinants Of Health ◽  
Fiscal Year ◽  
Readmission Rates ◽  
Validated Questionnaire ◽  
The Impact

Background: Chronic heart failure (CHF) affects more than 5 million Americans and accounts for approximately 1 million hospitalizations annually. Readmission in CHF patients is associated with higher mortality and consumes a significant portion of hospital resources. Readmission rates may be higher when socioeconomic factors limit medication compliance and follow-up. In light of the high prevalence of CHF and the penalties associated with readmission rates, our study aims to identify factors that place our veterans with CHF at higher risk for readmission and in so doing, develop a profile for patients with a high risk of readmission that will benefit from focused intervention. Our goal is to use the information acquired in this study to reduce CHF readmission in the Miami VAMC by 10% over a 12-month period. Methods: This is an ongoing retrospective study conducted at the Miami VAMC. The Strategic Analysis for Improvement and Learning (SAIL) report was used to identify patients with CHF who were admitted to the Miami VAMC over fiscal year 2019 (FY19), the period from September 2018 to August 2019. Data was collected on various clinical baseline characteristics and social determinants of health from the patients' electronic health records for those admitted as well as for those with recurrent admissions within FY19. Using a previously validated questionnaire, identified patients will undergo further interview, in person or by phone, to identify social factors that may place them at higher risk for readmission. Results/Anticipated Results: A total of 185 patients were admitted during FY19 and of these, 38 had recurrent admissions. The mean time to readmission was 82 days. 76% of the patients readmitted had heart failure with reduced ejection fraction. Multiple co-morbidities were seen in the readmitted group, the commonest being hypertension (82%), diabetes (63%) and chronic kidney disease (39%). Thirty percent of those readmitted had a history of illicit drug use compared to 26% of those who were not readmitted. This population was also found to have multiple psychiatric co-morbidities - depression, anxiety and post-traumatic stress disorder. The odds of having one or more readmission within 12 months was 25% greater in those with psychiatric illness than in those without. Conclusion: Preliminary data analysis shows that psycho-social factors may play a role in recurrent admission in CHF patients. Further data will be collected to determine the impact of factors such as housing, education level and income on readmission risk so that patients at high risk can be identified and targeted with improved care co-ordination services to reduce this risk. As a unified health system, the VAMC is uniquely equipped with resources to address these disparities.

Pneumococcal vaccination in older adults: An initial analysis of social determinants of health and vaccine uptake

Vaccine ◽  
2020 ◽  
Vol 38 (35) ◽  
pp. 5607-5617 ◽  
Author(s):  
Justin Gatwood ◽  
Sohul Shuvo ◽  
Kenneth C. Hohmeier ◽  
Tracy Hagemann ◽  
Chi-Yang Chiu ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Pneumococcal Vaccination ◽  
Determinants Of Health ◽  
Vaccine Uptake ◽  
Initial Analysis

Subgroups of High-Risk Veterans Affairs Patients Based on Social Determinants of Health Predict Risk of Future Hospitalization

Medical Care ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Dan V. Blalock ◽  
Matthew L. Maciejewski ◽  
Donna M. Zulman ◽  
Valerie A. Smith ◽  
Janet Grubber ◽  
...  
Keyword(s):  
High Risk ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Veterans Affairs ◽  
Determinants Of Health

scholarly journals How Many Individuals with Asthma Need to Be Vaccinated to Prevent One Case of Invasive Pneumococcal Disease?

2014 ◽  
Vol 25 (3) ◽  
pp. 147-150 ◽  
Author(s):  
Julie M Okapuu ◽  
Estelle Chétrit ◽  
Brigitte Lefebvre ◽  
Caroline Quach
Keyword(s):  
High Risk ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Pneumococcal Vaccination ◽  
Low Risk ◽  
Risk Category ◽  
Healthy Individuals ◽  
Asthmatic Children ◽  
High Risk Category ◽  
High Risk Children

BACKGROUND: The American Advisory Committee on Immunization Practices recommended the inclusion of adults with asthma in the high-risk category for pneumococcal vaccination based on a twofold increase in risk of invasive pneumococcal disease (IPD).OBJECTIVE: To determine whether, among individuals with asthma, the number needed to vaccinate (NNV) using pneumococcal conjugate vaccine (PCV)-13 or 23-valent pneumococcal polysaccharide vaccine (PPV-23) warrants its addition to the high-risk category for pneumococcal vaccination in Canada.METHODS: Using IPD incidence (per 10,000 individuals) figures from published articles (4.2 in high-risk asthmatics, 2.3 in low-risk asthmatics and 1.2 in healthy individuals), the NNV to prevent one case of IPD in asthmatics five to 17 years of age and 18 to 50 years of age was calculated, factoring in the proportion of pneumococcal serotypes included in vaccines (based on data from Quebec) and accounting for the possibility of waning vaccine efficacy (VE) using four scenarios.RESULTS: Assuming a VE of 65% for PCV-13 in asthmatics, the NNV would be 704 to 820 in low-risk and 386 to 449 in high-risk children; and 355 to 1532 in low-risk and 195 to 839 in high-risk adults (range depends on waning scenario). Assuming a VE of 65% for PPV-23 in asthmatics, the NNV would be 581 to 677 in low-risk and 318 to 371 in high-risk children; and 246 to 1059 in low-risk and 135 to 580 in high-risk adults.CONCLUSION: The NNV with both PCV-13 and PPV-23 in asthmatic children and adults is comparable with that of other high-risk conditions such as age ≥65 years. Therefore, the addition of asthma to the list of high-risk conditions for pneumococcal vaccination is warranted.

Social determinants of health among residential areas with a high tuberculosis incidence in a remote Inuit community

2019 ◽  
Vol 73 (5) ◽  
pp. 401-406 ◽  
Author(s):  
Elaine Kilabuk ◽  
Franco Momoli ◽  
Ranjeeta Mallick ◽  
Deborah Van Dyk ◽  
Christopher Pease ◽  
...  
Keyword(s):  
Missing Data ◽  
High Risk ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Multivariable Analysis ◽  
Determinants Of Health ◽  
Residential Areas ◽  
Prevention Campaign ◽  
Risk Ratios ◽  
Crowded Housing

BackgroundTuberculosis (TB) remains a significant health burden among Inuit in Canada. Social determinants of health (SDH) play a key role in TB infection, disease and ongoing transmission in this population. The objective of this research was to estimate the prevalence of social determinants of Inuit health as they relate to latent TB infection (LTBI) among people living in residential areas at high risk for TB in Iqaluit, Nunavut.MethodsInperson home surveys were conducted among those who lived in predetermined residential areas at high risk for TB identified in a door-to-door TB prevention campaign in Iqaluit, Nunavut in 2011. Risk ratios for SDH and LTBI were estimated, and multiple imputation was used to address missing data.Results261 participants completed the questionnaire. Most participants identified as Inuit (82%). Unadjusted risk ratios demonstrated that age, education, smoking tobacco, crowded housing conditions and Inuit ethnicity were associated with LTBI. After adjusting for other SDH, multivariable analysis showed an association between LTBI with increasing age (relative risk, RR 1.07, 95% CI 1.04 to 1.11), crowded housing (RR 1.48, 95% CI 1.10 to 2.00) and ethnicity (RR 2.76, 95% CI 1.33 to 5.73) after imputing missing data.ConclusionAmong high-risk residential areas for TB in a remote Arctic region of Canada, crowded housing and Inuit ethnicity were associated with LTBI after adjusting for other SDH. In addition to strong screening and treatment programmes, alleviating the chronic housing shortage will be a key element in the elimination of TB in the Canadian Inuit Nunangat.

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