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Impact of health insurance status on vaccination coverage among adult populations
  • Published Date:
    Apr 15 2015
  • Source:
    Am J Prev Med. 48(6):647-661.
Filetype[PDF-183.02 KB]

  • Alternative Title:
    Am J Prev Med
  • Description:

    Underinsurance has been a barrier to vaccination among children. Information on vaccination among adults ≥18 years by insurance status is limited.


    To assess vaccination coverage among adults ≥18 years in the United States in 2012 by health insurance status and access to care characteristics.


    The 2012 NHIS data were analyzed in 2014 to estimate vaccination coverage among adults ≥18 years by health insurance status for 7 vaccines routinely recommended for use. For the non-influenza vaccination coverage estimates among adults ≥18 years, regular descriptive analysis was used. To better assess influenza vaccination coverage for the 2011–12 influenza season, coverage was reported by restricting to individuals interviewed during September 2011 through June 2012, and vaccinated during August 2011 through May 2012, using the Kaplan-Meier survival analysis procedure.


    Overall, for all age groups, vaccination coverage was lower among those without health insurance compared with those with health insurance for all except HepA vaccination. Influenza vaccination coverage among adults ≥18 years without or with health insurance was 14.4% versus 44.3%, respectively, pneumococcal vaccination coverage among adults 18–64 years with high-risk conditions was 9.8% versus 23.0%, Td coverage (≥18 years) was 53.2% versus 64.5%, Tdap coverage (≥18 years) was 8.4% versus 15.7%, HepA coverage (18–49 years) was 16.6% versus 19.8%, HepB coverage (18–49 years) was 27.5% versus 38.0%, shingles coverage (≥60 years) was 6.1% versus 20.8%, and HPV coverage (female 18–26 years) was 20.9% versus 39.8%. In addition, vaccination coverage differed by type of insurance, whether or not respondents had a regular physician, or number of physician contacts. Persons without health insurance were less likely than those with health insurance to be vaccinated for influenza (≥18 years), pneumococcal (18–64 years with high-risk conditions), tetanus (≥18 years), Tdap (≥18 years), and HPV (women 18–26 years) after adjusting for confounders.


    Overall, vaccination coverage among adults ≥18 years was lower among uninsured populations. Implementing effective strategies are needed to help improve vaccination coverage among adults ≥18 years, especially those without health insurance.

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