Burden of vaccine-preventable disease in adult Medicaid and commercially insured populations

Abstract

Vaccination rates among United States (US) adults are suboptimal, resulting in morbidity, mortality, and financial burden attributable to potentially vaccine-preventable diseases (VPDs). Unadjusted annual incidence proportions of VPDs were estimated for Medicaid and commercially insured adults aged 19–64 years using 2006–2010 claims, along with age/gender-adjusted incidence proportions for 2010. In 2010, 1.6 million Medicaid adults (mean age 34 ± 12 years; 73.4% female) and 33 million commercially insured (mean age 42 ± 13 years; 52.2% female) were included. Age/gender-adjusted incidence proportions (per 100 000) in 2010 among Medicaid vs commercially insured adults for meningococcal disease were 26.2 (95% CI 22.9–29.8) vs 2.0 (1.9–2.2) (P < 0.001); hepatitis B 88.9 (82.6–95.6) vs 17.5 (17.0–17.9) (P < 0.001); pneumococcal disease 98.2 (91.7–105.1) vs 21.1 (20.7–21.6) (P < 0.001); hepatitis A 19.8 (16.9–23.1) vs 4.5 (4.3–4.7) (P < 0.001); mumps 2.1 (1.3–3.3) vs 1.4 (1.3–1.6) (P = 0.14); measles 0.3 (0.1–1.0) vs 0.3 (0.2–0.3) (P = 0.38); herpes zoster (60- to 64-year-olds only) 459 (408–515) vs 473 (466–481) (P = 0.35); varicella (19- to 39-year-olds only) 6.5 (4.8–8.5) vs 8.0 (7.5–8.5) (P = 0.12); influenza 586 (573–598) vs 633 (631–636) (P < 0.001); and pertussis 1.8 (1.1–2.8) vs 3.2 (3.0–3.4) (P < 0.001). Research is needed to fully understand the causes of the disparity of the coded incidence of some VPDs in adult Medicaid population than commercially insured adults in the US.

Keywords: :

• Medicaid
• commercially insured
• vaccine-preventable diseases
• immunization adults
• health disparity

10.4161/hv.29303

Disclosure of Potential Conflicts of Interest

G.K., C.C., J.P., B.A., and S.B. are full-time employees of the GlaxoSmithKline Group of Companies and hold restricted shares in the GlaxoSmithKline Group of Companies as part of their employment. M.L. (and/or his institution) has received funding from the GlaxoSmithKline Group of Companies to complete the work disclosed in this manuscript and fees for participation in review activities for an adjudication committee. M.L. also declares to have received consulting fees from Merck, Sharpe and Dohme for an Advisory Board and grant support for studies from the GlaxoSmithKline Group of Companies and Merck, Sharpe and Dohme. Additionally, M.L. receives royalties from Merck, Sharpe and Dohme for a patent.

Acknowledgments

We thank Dr Jenny Lloyd of Compass Medical Communications Ltd. who provided medical writing services on behalf of the GlaxoSmithKline Group of Companies; Heather Santiago (GlaxoSmithKline publication manager) for editorial assistance and manuscript coordination; Ning Wu for editorial assistance on behalf of GlaxoSmithKline Group of Companies; Aaron Rak for his contribution to the study idea and defining the methods for the study; and Dr Hoa Le for help with the age/gender-adjustment methodology and validation of this project analysis.

Role of the funding source: GlaxoSmithKline Biologicals SA funded this study/research and was involved in all stages of study conduct, including study design; collection, analysis, and interpretation of the data; writing the report; and the decision to submit the paper for publication. GlaxoSmithKline Biologicals SA also paid all costs associated with the development and publication of this manuscript.

Contributions: G.K.: scientific input, methods selection, literature review, acquisition of data, statistical analysis, and support for the statistical report. C.C.: assisted with the development of the methodology, programmed all analyses, and reviewed the codes and manuscript. J.P.: helped with the development of the methodology and programming support, project management, review of codes, and review of the manuscript. B.A.: methodology selection, model population, sensitivity analysis, review of the study report. S.B.: scientific input in data evaluation and study report. M. Levin: scientific input, literature review, statistical analysis, scientific input into the study report. All authors had full access to the data, agreed with the submission of the publication, and approved the final article.