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. 2025 May 4;25(1):653.
doi: 10.1186/s12879-025-11014-1.

Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada

Razan Amoud  1   2 , Jeffrey C Kwong  2   3   4   5 , Colleen Maxwell  1   4 , Suzanne L Tyas  6 , Martin Cooke  6   7 , Alejandro Hernandez  4 , Wasem Alsabbagh  8
Affiliations

Validation of influenza vaccination status using health administrative databases by integrating pharmacy claims and medical billing databases in Ontario, Canada

Razan Amoud et al. BMC Infect Dis. .

Abstract

Background: Determining vaccination status among the population is key for vaccine research and surveillance. This study aimed to validate the combined use of Ontario Health Insurance Program (OHIP) physician billing claims and Ontario Drug Benefit program (ODB) pharmacist billing claims against data from the Canadian Community Health Survey (CCHS).

Methods: OHIP and ODB billing claims databases were linked to 2013-2014 CCHS data, which contain self-reported seasonal influenza vaccination status of respondents (the reference standard). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and their associated 95% confidence intervals (CIs) were estimated. Subgroup analyses were performed based on key respondent characteristics, including having a regular medical doctor and the presence of risk factors for influenza complications.

Results: There were 31,390 eligible CCHS respondents aged ≥ 12 years in Ontario who responded to the influenza vaccination questions and agreed to have their responses linked to health administrative databases. More than half (55%) were female, 29% were aged ≥ 65 years, 93% had a regular medical doctor, and 54% had one or more risk factors for influenza complications. The sensitivity for the combined administrative databases was 60.1% (95% CI, 59.3%-61.0%), specificity was 98.5% (95% CI, 98.3%-98.7%), PPV was 96.7% (95% CI, 96.3%-97.1%), and NPV was 76.9% (95% CI, 76.4%-77.5%). Sensitivity was higher among those aged ≥ 65 years (72.7%; 95% CI, 71.6%-73.7%), with a regular medical doctor (61.1%; 95% CI, 60.3%-62.0%), and those with at least one risk factor for influenza complications (65.8%; 95% CI, 64.9%-66.8%).

Conclusion: Combining administrative physician and pharmacy claims data in Ontario results in moderate sensitivity but very high specificity and PPV, demonstrating that they can be a valid measure of influenza vaccination status.

Keywords: Administrative Health Data; Immunization; Influenza Vaccination; Pharmacist; Validation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval for this study was obtained from the University of Waterloo, Office of Research Ethics (CREB# IRB00007409, HREB# IRB00002419) in accordance with the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2), Canada. ICES is an independent, non-profit research institute whose legal status under Ontario’s health information privacy law allows it to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement. Consent for publication: We declare that all authors participated in the design, conduct, and analysis of the study and that all authors have seen and approved the submitted manuscript. The manuscript reflects original research and has not been published and is not being considered for publication elsewhere, in whole or in part, in any language, except as an abstract. All authors also attest they meet the ICMJE criteria for authorship. We also declare that we have no conflict of interest in connection with this paper. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study sample for Canadian Community Health Survey 2013/2014 respondents. OHIP = Ontario Health Insurance Plan, CCHS = Canadian Community Health Survey
See this image and copyright information in PMC

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