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. 2021 Dec;68(12):e29351.
doi: 10.1002/pbc.29351. Epub 2021 Sep 20.

Influenza vaccination rates and hospitalizations among Medicaid enrollees with and without sickle cell disease, 2009-2015

Amanda B Payne  1 , Thomas V Adamkiewicz  2 , Scott D Grosse  1 , Andrea Steffens  3 , David K Shay  3 , Carrie Reed  3 , Laura A Schieve  1
Affiliations

Influenza vaccination rates and hospitalizations among Medicaid enrollees with and without sickle cell disease, 2009-2015

Amanda B Payne et al. Pediatr Blood Cancer. 2021 Dec.

Abstract

Background: Personswith sickle cell disease (SCD) face increased risks for pulmonary and infection-related complications. This study examines influenza vaccination coverage and estimates influenza-related morbidity among Medicaid enrollees with and without SCD.

Procedure: Influenza vaccination coverage and hospitalizations related to influenza and pneumonia/acute chest syndrome (ACS) during each influenza season from 2009-2010 to 2014-2015 were assessed among enrollees in the IBM MarketScan® Multi-State Medicaid Database. Enrollees with SCD were identified as enrollees with greater than or equal to three claims listing SCD within a 5-year period during 2003-2017. Vaccinations were identified in outpatient claims. Hospitalizations associated with influenza or pneumonia/ACS were identified using inpatient claims. This study includes a series of cross-sectional assessments by season.

Results: From 2009-2010 through 2014-2015 seasons, the SCD sample ranged from 5044 to 8651 enrollees; the non-SCD sample ranged from 1,841,756 to 3,796,337 enrollees. Influenza vaccination coverage was higher among enrollees with SCD compared with enrollees without SCD for all seasons (24.5%-33.6% and 18.2%-22.0%, respectively). Age-standardized rates of influenza-related hospitalizations were 20-42 times higher among SCD enrollees compared with non-SCD enrollees, and ACS/pneumonia hospitalizations were 18-29 times higher. Among enrollees with SCD, influenza-related hospitalization rates were highest among children aged 0-9 years. Among enrollees without SCD, influenza-related hospitalization rates were highest among adults aged 40-64 years.

Conclusions: Although vaccine coverage was higher in persons with versus without SCD, efforts to increase influenza coverage further are warranted for this high-risk group, who experienced markedly higher rates of influenza and ACS/pneumonia hospitalizations during each season.

Keywords: influenza; sickle cell disease; vaccination coverage.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that there is no relevant conflict of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Estimates of influenza vaccination coverage among enrollees in the IBM MarketScan® Multi-State Medicaid Database with and without sickle cell disease (SCD), overall and by age group and basis of Medicaid eligibility across influenza seasons 2009–2010 through 2014–2015. SCD: Sickle cell disease; enrollees in the MarketScan Multi-State Medicaid database with three or more codes for SCD in a 5-year period. Non-SCD: Enrollees in the MarketScan Multi-State Medicaid database that did not meet the criteria for SCD. Eligibility for inclusion determined per season based on continuous enrollment 12 months before and 12 months after the start of the influenza season
FIGURE 2
FIGURE 2
Comparison of influenza vaccination coverage among enrollees in the IBM MarketScan® Multi-State Medicaid database with and without sickle cell disease (SCD), overall and by age group and basis of Medicaid eligibility across influenza seasons 2009–2010 through 2014–2015. SCD: Sickle cell disease; enrollees in the MarketScan Multi-State Medicaid database with three or more codes for SCD in a 5-year period. Non-SCD: Enrollees in the MarketScan Multi-State Medicaid database that did not meet the criteria for SCD. Eligibility for inclusion determined per season based on continuous enrollment 12 months before and 12 months after the start of the influenza season. Coverage ratio: Average across all seasons of the ratio of vaccination coverage among enrollees with SCD to the vaccination coverage among enrollees without SCD
FIGURE 3
FIGURE 3
Differences in vaccination coverage among persons with sickle cell disease (SCD) enrolled in the IBM® MarketScan® Multi-State Medicaid database by markers of care across influenza seasons 2009–2010 through 2014–2015. SCD: Sickle cell disease; enrollees in the MarketScan Multi-State Medicaid database with three or more codes for SCD in a 5-year period. Non-SCD: Enrollees in the MarketScan Multi-State Medicaid database that did not meet the criteria for SCD. Eligibility for inclusion determined per season based on continuous enrollment 12 months before and 12 months after the start of the influenza season
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