What drives vaccine coverage levels?
As a surprise to few, there is a large disparity of care in the United States when it comes to vaccination. Jason Baumgartner, the Life Sciences Consulting Director at Quintiles, highlighted a recent study they performed that shows all too well the magnitude of that disparity and perhaps some of the socioeconomic drivers of that gap. In the study, they looked at vaccine coverage rates and attempted to find a correlation with any of several dozen factors. That list of variables considered included poverty rate, high school and college graduation rates, median household income, physicians per 100 patients, health care expenditures per capita and insurance coverage levels.
He walked through two case studies, one for meningococcal ACWY and one for HPV. For meningococcal vaccine, the national average coverage rate is 54% and there are noticeably more states above the 50% level than there are below. Washington DC had the highest coverage rate at 78%. Possible reasons for this include having 4x the number of physicians per 1000 patients as anywhere else in the country as well as a high percentage of the population who have completed bachelor’s degrees. Rhode Island also had great coverage, mostly due to a program that made vaccines available at area schools. The factor with the largest correlation was the number of physicians per 1000 patients. Interestingly, things that would seem like they have a correlation, such as health care expenditures per capita, had no correlation to the coverage level.
The other case study was the HPV vaccine, for which the national average coverage rate is only 27%. As a contrast to meningococcal, far more states were below that average. The state with the best coverage was Massachusetts, which has the lowest percentage of the population that was uninsured, a high rate of OB/GYNs per 1000 patients and a low percentage of children who attend religious services weekly. That last factor was actually the one with the highest correlation, albeit an inverse one.
These case studies suggest how we can improve coverage levels:
- Optimize the delivery channel (the schools in Rhode Island being an illuminating example)
- Address cultural and geographic variations
- Engage both patients and influencers early and often
Ultimately, coverage level is strongly correlated with the access to care.
What are your thoughts? Comment below.