Influenza Vaccination Coverage Among People With High-Risk Conditions in the U.S

During annual influenza epidemics, rates of serious illness and death are higher among those who have medical conditions, such as pulmonary disease, diabetes, or heart disease, which place them at increased risk of influenza complications. Annual influenza vaccination was recommended for people with high-risk conditions as early as 1960.

Data from the 2012-2013 Behavioral Risk Factor Surveillance System were analyzed in 2014 to estimate national and state-specific influenza vaccination coverage among people aged 18-64 years with high-risk conditions. Prevalence ratios adjusted for demographic and access-to-care characteristics were calculated using logistic regression and predictive marginal models.

Unadjusted influenza vaccination coverage was 45.4% among adults aged 18-64 years with at least one high-risk condition, compared with 32.9% among those with no high-risk conditions (p<0.05). Among adults aged 18-64 years with multiple conditions (at least two high-risk conditions), vaccination coverage was 53.2%. Coverage was 43.9% for those with pulmonary diseases, 52.7% for those with diabetes, 48.1% for those with heart disease, and 45.0% for those with cancer. Individuals with high-risk conditions were more likely to receive an influenza vaccine than those with no high-risk conditions, even after controlling for demographic and access-to-care characteristics.

Despite ongoing influenza vaccination recommendations for adults with high-risk conditions, coverage was below the Healthy People 2020 target; only about half were vaccinated. Primary care providers and subspecialists should ensure routine assessment of vaccination status every fall and winter and recommend vaccination to people with high-risk conditions.