A Population-Based Cohort Study of Undervaccination in 8 Managed Care Organizations Across the United States | Neonatology | JAMA Pediatrics | JAMA Network
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Article
March 2013

A Population-Based Cohort Study of Undervaccination in 8 Managed Care Organizations Across the United States

Author Affiliations

Author Affiliations: Institute for Health Research, Kaiser Permanente Colorado, Denver (Drs Glanz, Narwaney, Hambidge, Daley, McClure, and Xu and Mss Wagner and Newcomer); Department of Epidemiology, Colorado School of Public Health, Aurora (Drs Glanz and Hambidge); Community Health Services, Denver Health, Denver (Dr Hambidge); Department of Pediatrics, University of Colorado, Aurora (Drs Hambidge and Daley); Kaiser Permanente Vaccine Study Center, Oakland, California (Dr Rowhani-Rahbar); Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts (Dr Lee); Group Health Cooperative, Seattle, Washington (Dr Nelson); Marshfield Clinic Research Foundation, Marshfield, Wisconsin (Dr Donahue); Kaiser Permanente Northwest, Portland, Oregon (Dr Naleway); HealthPartners Research Foundation, Minneapolis, Minnesota (Dr Nordin); Department of Research and Evaluation, Southern California Kaiser Permanente, Pasadena (Dr Lugg); and Immunization Safety Office, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (Mr Weintraub).

JAMA Pediatr. 2013;167(3):274-281. doi:10.1001/jamapediatrics.2013.502
Abstract

Objectives To examine patterns and trends of undervaccination in children aged 2 to 24 months and to compare health care utilization rates between undervaccinated and age-appropriately vaccinated children.

Design Retrospective matched cohort study.

Setting Eight managed care organizations of the Vaccine Safety Datalink.

Participants Children born between 2004 and 2008.

Main Exposure Immunization records were used to calculate the average number of days undervaccinated. Two matched cohorts were created: 1 with children who were undervaccinated for any reason and 1 with children who were undervaccinated because of parental choice. For both cohorts, undervaccinated children were matched to age-appropriately vaccinated children by birth date, managed care organization, and sex.

Main Outcome Measures Rates of undervaccination, specific patterns of undervaccination, and health care utilization rates.

Results Of 323 247 children born between 2004 and 2008, 48.7% were undervaccinated for at least 1 day before age 24 months. The prevalence of undervaccination and specific patterns of undervaccination increased over time (P < .001). In a matched cohort analysis, undervaccinated children had lower outpatient visit rates compared with children who were age-appropriately vaccinated (incidence rate ratio [IRR], 0.89; 95% CI, 0.89- 0.90). In contrast, undervaccinated children had increased inpatient admission rates compared with age-appropriately vaccinated children (IRR, 1.21; 95% CI, 1.18-1.23). In a second matched cohort analysis, children who were undervaccinated because of parental choice had lower rates of outpatient visits (IRR, 0.94; 95% CI, 0.93-0.95) and emergency department encounters (IRR, 0.91; 95% CI, 0.88-0.94) than age-appropriately vaccinated children.

Conclusions Undervaccination appears to be an increasing trend. Undervaccinated children appear to have different health care utilization patterns compared with age-appropriately vaccinated children.

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