Brief report: risk factors for pneumococcal vaccine refusal in adults: a casecontrol study.

Abstract

BACKGROUND: Invasive pneumococcal disease is a significant cause of morbidity and mortality in the United States. Despite availability of an effective vaccine, many patients refuse vaccination. OBJECTIVE: To investigate patient characteristics and features of the patient-provider relationship associated with pneumococcal vaccine refusal. DESIGN: Case-control study using chart review. PATIENTS: Five hundred adults from the medical clinics of a 1,000-bed inner-city teaching hospital. MEASUREMENTS AND MAIN RESULTS: Independent risk factors for pneumococcal vaccine refusal included patient-provider gender discordance (odds ratio (OR)=2.09, 95% confidence interval (CI) 1.07 to 4.09); a visit to a not-usual provider at the time of vaccine offering (OR=2.26, 95% CI 1.13 to 4.49); never having received influenza vaccination (OR=7.44, 95% CI 3.76 to 14.76); prior pneumococcal vaccine refusals (OR=3.45, 95% CI 1.60 to 7.43); and a history of ever having refused health maintenance tests (OR=2.86, 95% CI 1.40 to 5.84). CONCLUSIONS: We have identified both patient factors and factors related to the patient-provider relationship that are risk factors for pneumococcal vaccine refusal. By identifying patients at risk for pneumococcal vaccine refusal, efforts to increase vaccination rates can be better targeted.