Determinants of Hepatitis B Vaccination Among Adults in the United States
Conschetta Wright
Purpose: The primary objective of this study was to estimate the prevalence of vaccination and HBV infection status of adults and to evaluate the trend in self reported vaccination and seroprevalence for Hepatitis B for this population. Additionally, this study sought to assess the association between vaccination rates, seroprevalence (HBsAg and anti-HBc), demographic (age, gender, location of birth, race/ethnicity), and socioeconomic (annual household income, education level, insurance coverage and access to care, marital status) characteristics.
Methods: Eight years, 1999-2006, of the National Health and Nutrition Examination Survey (NHANES) data were used. NHANES participants aged 20-59 years who contributed data via the household interview and laboratory component were eligible for this study. All analyses were weighted to consider the complex weighting scheme and adjusted to the 2000 US census population. Vaccination rates were calculated for both low and high risk populations. 95% confidence intervals (95% CI) of each estimate were also calculated. The association between potential predictors of vaccination (demographic variables, socioeconomic status, high risk, and health care access and utilization variables) and vaccination status was assess using bivariate analysis. We used logistic regression model to obtain odds ratios and their 95% confidence intervals for the association between predictor variables and vaccination status after adjusting for all potential confounding factors.
Results: The adjusted model shows that males are almost 40% less likely to be vaccinated compared to females (OR=0.64, 95% CI [0.57, 0.73]). Adults aged 50-59 were least likely to be vaccinated. Vaccination odds increased with every decrease in decade with 20-29 year olds three times more likely to be vaccinated (OR=3.69 95% CI [2.98, 4.56]). In this study we estimated that almost 15 million adults were at risk of HBV. Of the high risk population only 32% were reported vaccinated. When comparing the self reported vaccination status with serologic status, almost half of the adults who reported receiving all three doses of the vaccine were not vaccinated. About 4.5% of adults who reported receiving no doses were seropositive for the vaccination
Conclusion: These data indicate that HBV vaccination among adtuls is lower than the Healthy People 2010 objectives. More targeted interventions are needed to educate and vaccinate the adult population and to create a means for identifying those at risk and those already vaccinated. Interventions should also be implemented to improve adult awareness about vaccinations that may have already received.
