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Influenza Vaccination Coverage Among Medicare Fee-for-Service Beneficiaries

      Introduction

      Influenza vaccination is the best prevention strategy to protect against influenza infection. Determining accurate influenza vaccination coverage is critical. This study assesses the concordance between self-reported and claimed-based influenza vaccination coverage and examines vaccination disparities in the U.S.

      Methods

      Data from the 2016–2019 Medicare Current Beneficiary Survey linked to survey participants’ influenza vaccination claims were analyzed in 2022. The study population included survey participants aged ≥65 years and enrolled in a Medicare fee-for-service plan. Sensitivity, specificity, kappa statistics, and net bias (the difference between the estimated vaccination coverage based on survey and claims data) were reported. Associations between receipt of influenza vaccine and beneficiaries’ characteristics and sex, racial and ethnic, and urban‒rural disparities in influenza vaccination were examined using logistic regressions.

      Results

      The analysis included 20,854 beneficiaries. Claimed-based vaccination coverage was 60.0%, and survey-based coverage was 76.3%. The net bias was 16.3 percentage points, and kappa statistic indicated moderate data agreement. The sensitivity of self-reported influenza vaccination was 98.7%, and the specificity was 57.4%. Net bias was high among male, non-Hispanic Black and Hispanic beneficiaries, and rural residents. Sex, racial and ethnic, and urban‒rural disparities in influenza vaccination were noticeably smaller according to the survey than claims data.

      Conclusions

      The level of data agreement differed by beneficiaries’ characteristics and was low among males, racial and ethnic minority groups, and rural residents.
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      REFERENCES

      1. Centers for Disease Control and Prevention. Estimated influenza illnesses, medical visits, hospitalizations, and deaths in the United States; 2018–2019 influenza season. https://www.cdc.gov/flu/about/burden/2018-2019.html. Updated September 29, 2021. Accessed April 26, 2021.

        • Grohskopf LA
        • Alyanak E
        • Ferdinands JM
        • et al.
        Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices, United States, 2021–22 influenza season.
        MMWR Recomm Rep. 2021; 70: 1-28https://doi.org/10.15585/mmwr.rr7005a1
        • Dietz V
        • Venczel L
        • Izurieta H
        • et al.
        Assessing and monitoring vaccination coverage levels: lessons from the Americas.
        Rev Panam Salud Publica. 2004; 16: 432-442https://doi.org/10.1590/S1020-49892004001200013
        • Boggavarapu S
        • Sullivan KM
        • Schamel JT
        • Frew PM.
        Factors associated with seasonal influenza immunization among church-going older African Americans.
        Vaccine. 2014; 32: 7085-7090https://doi.org/10.1016/j.vaccine.2014.10.068
        • Timofte D
        • Stoian AP
        • Hainarosie R.
        A review on the dvantages and disadvantages of using administrative data in surgery outcome studies.
        J Surgery. 2018; 14: 105-107https://doi.org/10.7438/1584-9341-14-3-3
        • Lochner KA
        • Wynne MA
        • Wheatcroft GH
        • Worrall CM
        • Kelman JA.
        Medicare claims versus beneficiary self-report for influenza vaccination surveillance.
        Am J Prev Med. 2015; 48: 384-391https://doi.org/10.1016/j.amepre.2014.10.016
        • Rolnick SJ
        • Parker ED
        • Nordin JD
        • et al.
        Self-report compared to electronic medical record across eight adult vaccines: do results vary by demographic factors?.
        Vaccine. 2013; 31: 3928-3935https://doi.org/10.1016/j.vaccine.2013.06.041
        • Irving SA
        • Donahue JG
        • Shay DK
        • Ellis-Coyle TL
        • Belongia EA.
        Evaluation of self-reported and registry-based influenza vaccination status in a Wisconsin cohort.
        Vaccine. 2009; 27: 6546-6549https://doi.org/10.1016/j.vaccine.2009.08.050
        • Fiscella K
        • Holt K
        • Meldrum S
        • Franks P.
        Disparities in preventive procedures: comparisons of self-report and Medicare claims data.
        BMC Health Serv Res. 2006; 6: 122https://doi.org/10.1186/1472-6963-6-122
        • Hebert PL
        • Frick KD
        • Kane RL
        • McBean AM.
        The causes of racial and ethnic differences in influenza vaccination rates among elderly Medicare beneficiaries.
        Health Serv Res. 2005; 40: 517-537https://doi.org/10.1111/j.1475-6773.2005.00370.x
        • Zimmerman RK
        • Raymund M
        • Janosky JE
        • Nowalk MP
        • Fine MJ
        Sensitivity and specificity of patient self-report of influenza and pneumococcal polysaccharide vaccinations among elderly outpatients in diverse patient care strata.
        Vaccine. 2003; 21: 1486-1491https://doi.org/10.1016/S0264-410X(02)00700-4
        • Nichol KL
        • Korn JE
        • Baum P.
        Estimation of outpatient risk characteristics and influenza vaccination status: validation of a self-administered questionnaire.
        Am J Prev Med. 1991; 7: 199-203https://doi.org/10.1016/S0749-3797(18)30913-9
      2. 2018 Medicare Current Beneficiary Survey (MCBS): frequently asked questionshttps://www.cms.gov/files/document/2018-mcbs-frequently-asked-questions.pdf. Updated July 31, 2020. Accessed April 26, 2022.

        • McHugh ML.
        Interrater reliability: the kappa statistic.
        Biochem Med (Zagreb). 2012; 22: 276-282https://doi.org/10.11613/BM.2012.031
        • Gordon NP
        • Wortley PM
        • Singleton JA
        • Lin TY
        • Bardenheier BH.
        Race/ethnicity and validity of self-reported pneumococcal vaccination.
        BMC Public Health. 2008; 8: 227https://doi.org/10.1186/1471-2458-8-227
        • Okoli GN
        • Abou-Setta AM
        • Neilson CJ
        • Chit A
        • Thommes E
        • Mahmud SM.
        Determinants of seasonal influenza vaccine uptake among the elderly in the United States: A systematic review and meta-analysis.
        Gerontol Geriatr Med. 2019; 52333721419870345https://doi.org/10.1177/2333721419870345
        • Okoli GN
        • Lam OLT
        • Racovitan F
        • et al.
        Seasonal influenza vaccination in older people: A systematic review and meta-analysis of the determining factors.
        PLOS ONE. 2020; 15e0234702https://doi.org/10.1371/journal.pone.0234702
      3. Annual influenza vaccination disparities in Medicare beneficiaries.https://www.cms.gov/files/document/data-snapshot-annual-influenza-vaccination.pdf. Updated November 2021. Accessed April 26, 2022.

        • Lu PJ
        • Hung MC
        • Srivastav A
        • et al.
        Surveillance of vaccination coverage among adult populations -United States, 2018.
        MMWR Surveill Summ. 2021; 70: 1-26https://doi.org/10.15585/mmwr.ss7003a1
      4. Centers for Disease Control and Prevention. Behavioral risk factor surveillance system. https://www.cdc.gov/brfss/index.html. Updated June 21, 2022. Accessed June 21, 2022.

      5. Centers for Disease Control and Prevention. National health interview survey. https://www.cdc.gov/nchs/nhis/index.htm. Updated July 11, 2022. Accessed July 11, 2022.

      6. Centers for Disease Control and Prevention. Flu vaccination coverage, United States; 2018–19 influenza season. https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm. Updated January 26, 2022. Accessed April 26, 2022.

      7. IIS Adult vaccination data capture and data utilization. https://repository.immregistries.org/files/resources/60958446cdad0/adultlandscape_final.pdf. Updated May 2021. Accessed May 25, 2022.