Despite longstanding recommendations for routine vaccination against influenza; pneumococcal; tetanus, diphtheria, acellular pertussis (Tdap); and herpes zoster (HZ) among the United States general adult population, vaccine uptake remains low. Understanding factors that influence adult vaccination and coverage variability beyond the national level are important steps toward developing targeted strategies for increasing vaccination coverage. A retrospective analysis was conducted using data from the Behavioral Risk Factor Surveillance System (2011–2014). Multivariable logistic regression modeling was employed to identify individual factors associated with vaccination (socio-demographics, health status, healthcare utilization, state of residence) and generate adjusted vaccination coverage and compliance estimates nationally and by state. Results indicated that multiple characteristics were consistently associated with a higher likelihood of vaccination across all four vaccines, including female sex, increased educational attainment, and annual household income. Model-adjusted vaccination coverage estimates varied widely by state, with inter-state variability for the most recent year of data as follows: influenza (aged ≥18 years) 30.2–49.5%; pneumococcal (aged ≥65 years) 64.0–74.7%; Tdap (aged ≥18 years) 18.7–46.6%; and HZ (aged ≥60 years) 21.3–42.9%. Model-adjusted compliance with age-appropriate recommendations across vaccines was low and also varied by state: influenza+Tdap (aged 18–59 years) 7.9–24.7%; influenza+Tdap+HZ (aged 60–64 years) 4.1–14.4%; and influenza+Tdap+HZ+pneumococcal (aged ≥65 years) 3.0–18.3%. In summary, after adjusting for individual characteristics associated with vaccination, substantial heterogeneity across states remained, suggesting that other local factors (e.g. state policies) may be impacting adult vaccines uptake. Further research is needed to understand such factors, focusing on differences between states with high versus low vaccination coverage.

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Objective To determine whether Medicare managed care penetration impacted the diffusion of endoscopy services (sigmoidoscopy, colonoscopy) among the fee-for-service (FFS) Medicare population during 2001–2006. Methods We model utilization rates for colonoscopy or sigmoidoscopy as impacted by both market supply and demand factors. We use spatial regression to perform ecological analysis of county-area utilization rates over two time intervals (2001–2003–2004–2006) following Medicare benefits expansion in 2001 to cover colonoscopy for persons of average risk. We examine each technology in separate cross-sectional regressions estimated over early and later periods to assess differential effects on diffusion over time. We discuss selection factors in managed care markets and how failure to control perfectly for market selection might impact our managed care spillover estimates. Results Areas with worse socioeconomic conditions have lower utilization rates, especially for colonoscopy. Holding constant statistically the socioeconomic factors, we find that managed care spillover effects onto FFS Medicare utilization rates are negative for colonoscopy and positive for sigmoidoscopy. The spatial lag estimates are conservative and interpreted as a lower bound on true effects. Our findings suggest that managed care presence fostered persistence of the older technology during a time when it was rapidly being replaced by the newer technology.

Hepatitis vaccine adherence and completion in adults is suboptimal. As a result, the majority of adults initiating each series may not be receiving the full protective benefit of these multidose vaccines.

Background Prostate-specific antigen (PSA) testing is recommended every 6 to 12 months for the first 5 years following radical prostatectomy as a means to detect potential disease recurrence. Despite substantial research on factors affecting treatment decisions, recurrence, and mortality, little is known about whether men receive guideline-concordant surveillance testing or whether receipt varies by year of diagnosis, time since treatment, or other individual characteristics. Methods Surveillance testing following radical prostatectomy among elderly men was examined using Surveillance, Epidemiology, and End Results cancer registry data linked to Medicare claims. Multivariate logistic regression was used to examine the effect of demographic, tumor, and county-level characteristics on the odds of receiving surveillance testing within a given one-year period following treatment. Results Overall, receipt of surveillance testing was high, with 96% of men receiving at least one test the first year after treatment and approximately 80% receiving at least one test in the fifth year after treatment. Odds of not receiving a test declined with time since treatment. Non-married men, men with less advanced disease, and non-Hispanic Blacks and Hispanics had higher odds of not receiving a surveillance test. Year of diagnosis did not affect the receipt of surveillance tests. Conclusion Most men receive guideline-concordant surveillance PSA testing after prostatectomy, although evidence of a racial disparity between non-Hispanic Whites and some minority groups exists. The decline in surveillance over time suggests the need for well-designed long-term surveillance plans following radical prostatectomy.