Influenza and pneumococcal vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with diabetes or asthma--United States, 2003

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy for preventing associated morbidity and mortality in the United States. Risk factors include older age and medical conditions that increase the risk for complications from infections. During the 1990-1999 influenza seasons, more than 32,000 deaths each year among persons aged > or =65 years were attributed to complications from influenza infection. National health objectives for 2010 call for 90% influenza and pneumococcal vaccination coverage among noninstitutionalized persons aged > or =65 years and 60% coverage among noninstitutionalized persons aged 18-64 years who have risk factors (e.g., diabetes or asthma) for complications from infections. To estimate influenza and pneumococcal vaccination coverage among these populations, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that 1) influenza vaccination levels among adults aged 18-64 with diabetes or asthma, 2) pneumococcal vaccination levels among adults aged 18-64 years with diabetes, and 3) influenza and pneumococcal vaccination levels among adults aged > or =65 years all were below levels targeted in the national health objectives for 2010. Moreover, vaccination coverage levels varied among states for both vaccines and both age groups. Innovative approaches and adequate, reliable supplies of vaccine are needed to increase vaccination coverage, particularly among adults with high-risk conditions.     

Influenza and pneumococcal vaccination levels among persons aged > or = 65 years--United States, 2001

Two vaccine-preventable diseases, influenza and pneumococcal disease, contribute to the mortality of older persons in the United States. Influenza caused an average of 20,000 deaths per year during influenza epidemics in the United States from 1969 to 1996; persons aged > or = 65 years accounted for approximately 90% of these deaths. Pneumococcal disease caused approximately 3,400 deaths among persons aged > or = 65 years in the United States in 1998. National health objectives for 2010 include increasing influenza and pneumococcal vaccination levels to > or = 90% among persons aged > or = 65 years (objective nos. 14.29a and 14.29b, respectively). To assess progress toward achieving these objectives, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results, which indicate that the estimated point prevalences of influenza and pneumococcal vaccination were <80% among persons aged > or = 65 years in all reporting areas. Influenza vaccination levels during 2000-2001 decreased from 1998-1999 levels in 27 of 52 reporting areas; pneumococcal vaccination prevalence increased a median of 7 percentage points from 1999 to 2001. Continued efforts are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Influenza and pneumococcal vaccination coverage among persons aged > or = 65 years--United States, 2004-2005

Vaccination of persons at increased risk for complications from influenza and pneumococcal disease is a key public health strategy in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or = 65 years. In 1998, an estimated 3,400 adults aged > or = 65 years died as a result of invasive pneumococcal disease. One of the Healthy People 2010 objectives is to achieve 90% coverage of noninstitutionalized adults aged > or = 65 years for both influenza and pneumococcal vaccinations (objective 14-29). To assess progress toward this goal, this report examines vaccination coverage for persons interviewed in the 2004 and 2005 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The 2004-05 influenza season was characterized by an influenza vaccine shortage. As a result, the Advisory Committee on Immunization Practices (ACIP) issued recommendations that influenza vaccine be reserved for persons in priority groups, including persons aged > or = 65 years, and that others should defer vaccination until supply was sufficient. The results of this assessment indicated that, overall, influenza vaccination coverage was lower in the 2005 survey year than in 2004, whereas pneumococcal vaccination coverage was nearly unchanged from 2004 to 2005. In both years, influenza and pneumococcal vaccination coverage varied from state to state. Continued measures are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Racial/ethnic disparities in influenza and pneumococcal vaccination levels among persons aged > or =65 years--United States, 1989-2001

Influenza and pneumococcal diseases are key causes of mortality among persons aged > or =65 years, accounting for approximately 36,000 and 3,400 deaths per year, respectively, during 1990-1999. Substantial racial/ethnic disparities in adult vaccination have been documented in national surveys. Although the national health objective for 2000 of 60% receipt of influenza vaccination during the preceding 12 months by persons aged > or =65 years (objective no. 20.11) was met in 1997, and the objective of 60% for pneumococcal vaccination was nearly met in 2000, vaccine coverage levels among non-Hispanic blacks and Hispanics were 31% and 30%, respectively, compared with 57% for non-Hispanic whites. To characterize these disparities, CDC analyzed data from the 2000 and 2001 National Health Interview Surveys (NHIS) and examined trends in NHIS results for 1989-2001. This report summarizes the results of these analyses, which indicate that marked differences in vaccination coverage by race/ethnicity are observed even among persons most likely to be vaccinated (e.g., persons with the highest education level and persons with frequent visits to health-care providers). Racial/ethnic disparities in influenza and pneumococcal vaccination coverage have persisted over time. Several approaches to reduce these disparities are needed, including increasing demand for vaccination among racial/ethnic minority populations and the use of standing orders and other systems changes that promote vaccination.     

Influenza vaccination and self-reported reasons for not receiving influenza vaccination among Medicare beneficiaries aged > or =65 years--United States, 1991-2002

Annual influenza vaccination of the U.S. elderly population has been demonstrated as safe and effective in reducing the risks of illness, hospitalization, and death. The Medicare Current Beneficiary Survey (MCBS) has measured annual influenza vaccination rates since 1991; the latest data available are for the 2001-02 influenza season. Since 1996, self-reported reasons for not receiving influenza vaccine also have been measured. During 1991-2002, MCBS indicated a steady upward trend in vaccination coverage among Medicare beneficiaries, with the exception of the 2000-01 influenza season, when vaccine distribution was delayed. The most frequently cited reasons for not receiving influenza vaccine were 1) not knowing that influenza vaccination was needed and 2) concerns that vaccination might cause influenza or side effects. During the 2000-01 influenza season, vaccine shortage or unavailability was noted for the first time as an important reason for nonvaccination. Further efforts are needed to educate the elderly regarding the benefits of influenza vaccination and to address any concerns regarding the safety of the vaccine.     

Public health and aging: influenza vaccination coverage among adults aged > or =50 years and pneumococcal vaccination coverage among adults aged > or =65 years--United States, 2002

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy in preventing morbidity and mortality in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or =65 years. In 1998, an estimated 3,400 adults aged > or =65 years died as a result of invasive pneumococcal disease. One of the national health objectives for 2010 is to achieve 90% coverage of noninstitutionalized adults aged > or =65 years for both influenza and pneumococcal vaccinations (objective no. 14.29). In 2000, the Advisory Committee on Immunization Practices (ACIP) broadened the universal recommendations for influenza vaccination to include adults aged 50-64 years in addition to adults aged > or =65 years. To assess progress toward achieving the 2010 national health objective and implementing the ACIP recommendations, CDC analyzed data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that influenza and pneumococcal vaccination levels among adults aged > or =65 years and influenza vaccination levels among adults aged 50-64 years varied widely among states/areas and racial/ethnic populations. Innovative approaches are needed to increase vaccination coverage, particularly among certain populations.     

State-specific influenza vaccination coverage among adults aged > or =18 years--United States, 2003-04 and 2005-06 influenza seasons

Influenza epidemics occur seasonally and result in substantial morbidity and mortality among adults in the United States. Adult groups included in the 2007 Advisory Committee on Immunization Practices (ACIP) recommendation for annual influenza vaccination are persons aged 18-49 years with high-risk conditions (i.e., conditions associated with an increased risk for complications from influenza), persons aged > or =50 years, health-care personnel, and others who are household contacts or caregivers of persons at high risk (e.g., persons with high-risk conditions or children aged < or =59 months). In addition, adults who want to reduce the risk for becoming ill with influenza or of transmitting influenza to others should be vaccinated. Healthy People 2010 (HP2010) objectives include increasing vaccination levels to 90% for adults aged > or =65 years (objective 14-29a) and 60% for persons aged 18-64 years who have one or more high-risk conditions (objective 14-29c). From the 1992-93 through 2003-04 influenza seasons, seasonal influenza vaccination coverage estimates (based on Behavioral Risk Factor Surveillance System [BRFSS] data) among adults aged > or =65 years trended upward, except for three seasons (1997-98, 1999-00, and 2000-01) when no increases occurred (Figure). To evaluate recent state-specific progress toward the HP2010 objectives, CDC compared data from the 2004 and 2006 BRFSS surveys, which reflected vaccinations received during the 2003-04 and 2005-06 influenza seasons; data from the 2004-05 influenza season, which have been published previously, were not included in this comparison because that season was marked by a substantial shortage of influenza vaccine. This report describes the results of the analysis, which indicated that influenza vaccination coverage for the 2005-06 season did not return to levels observed before the vaccine shortage of 2004-05 and remained substantially below HP2010 targets. Comprehensive measures are needed to improve influenza vaccination coverage among adult populations in the United States, including increasing adoption of recommended adult immunization practices by health-care providers, raising public awareness about influenza vaccination, vaccinating throughout the influenza season, and ensuring stable supplies of readily available vaccine.     

Self-reported falls and fall-related injuries among persons aged > or =65 years--United States, 2006

Each year, an estimated one third of older adults fall, and the likelihood of falling increases substantially with advancing age. In 2005, a total of 15,802 persons aged > or =65 years died as a result of injuries from falls. However, the number of older adults who fall and are not injured or who sustain minor or moderate injuries and seek treatment in clinics or physician offices is unknown. To estimate the percentage of older adults who fell during the preceding 3 months, CDC analyzed data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that approximately 5.8 million persons aged > or =65 years, or 15.9% of all U.S. adults in that age group, fell at least once during the preceding 3 months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least 1 day. The percentages of women and men who fell during the preceding 3 months were similar (16.4% versus 15.2%, respectively), but women reported significantly more fall-related injuries than men (35.7% versus 24.6%, respectively). The effect these injuries have on the quality of life of older adults and on the U.S. health-care system reinforces the need for broader use of scientifically proven fall-prevention interventions.     

Influenza vaccination coverage among persons aged 50-64 years enrolled in commercial managed health-care plans--United States, 2003-04 and 2004-05 influenza seasons

To combat an unexpected shortage of influenza vaccine in the fall of 2004, CDC issued guidance to direct available vaccine supplies to persons in designated priority groups (e.g., persons aged >/=65 years, persons with certain health conditions, health-care workers, and close contacts of persons at high risk for complications from influenza). Analyses of influenza vaccination coverage for the 2004-05 influenza season indicated that coverage levels for adults in priority groups nearly reached the levels of previous years, whereas coverage levels among adults not in priority groups were approximately half the levels of the 2003-04 season. These findings suggested that national public health actions to direct available vaccine supply to persons at high risk for complications from influenza during the supply disruption were successful. To assess influenza vaccination coverage among persons aged 50-64 years for the 2004-05 influenza season relative to the 2003-04 season and to estimate the effect of shortages on selected subgroups, the National Committee for Quality Assurance (NCQA) analyzed data from a survey of persons enrolled in commercial managed care health plans. This report summarizes the findings of that analysis, which indicated that, although vaccination coverage declined substantially from 2003-04 to 2004-05 among all subgroups in this age range, respondents who were older or who reported poorer health status exhibited smaller relative declines in vaccination coverage between the two seasons.     

Lower extremity disease among persons aged > or =40 years with and without diabetes--United States, 1999-2002

Lower extremity disease (LED), including peripheral arterial disease (PAD) and peripheral insensate neuropathy (PN), is a chronic condition that disproportionately affects older persons and persons with diabetes. LED can result in disabling foot complications (e.g., ulcers, infection, gangrene, or amputation). PAD has been associated with increased risk for cardiovascular morbidity and mortality. For this report, CDC analyzed data collected during 1999-2002 from the National Health and Nutrition Examination Survey (NHANES) to update previously published estimates of the prevalence of LED among persons aged > or =40 years with and without diabetes. The results of this analysis indicated that approximately 18% of persons aged > or =40 years had LED and that LED was twice as prevalent among persons with diabetes as among those without diabetes. Approximately two thirds of persons with LED and half of those with both diabetes and LED were asymptomatic. Multiple complications of LED can be prevented if LED is detected early. Increasing knowledge among clinicians and the public of the prevalence of LED and associated risk factors might lead to early detection, intervention, and treatment to prevent disabling consequences.     

Prevalence of self-reported cardiovascular disease among persons aged > or =35 years with diabetes--United States, 1997-2005

Adults with diabetes are at greater risk for dying from heart disease than adults without diabetes. Heart disease and stroke account for approximately 65% of deaths among persons with diabetes. During 1997-2005, the age-adjusted prevalence of diagnosed diabetes in the United States increased 43%, from 3.7% in 1997 to 5.3% in 2005. To assess trends in prevalence of heart disease, stroke, and other cardiovascular diseases (CVDs) among persons with diabetes, CDC analyzed data from the National Health Interview Survey (NHIS). This report summarizes the results of that assessment, which indicated that although the number of persons aged > or =35 years with diagnosed diabetes who reported having CVD increased 36% during 1997-2005, the age-adjusted prevalence decreased 11%; however, the decrease in CVD prevalence did not occur in all subpopulations with diabetes. The decrease in CVD prevalence indicates that the increase in the number of persons with diagnosed diabetes exceeded the increase in the number of persons with diagnosed diabetes who reported having a CVD. Continued interventions are needed to reduce modifiable CVD risk factors among persons with diabetes, better control diabetes, and decrease CVD prevalence further.     

Total tooth loss among persons aged > or =65 years--selected states, 1995-1997

Loss of all natural permanent teeth (edentulism) substantially reduces quality of life, self-image, and daily functioning. Although loss of teeth results from oral diseases such as dental caries and periodontitis, it also reflects patient and dentist attitudes, availability and accessibility of dental care, and the prevailing standard of care. One of the national health objectives for 2000 is to reduce to no more than 20% the proportion of persons aged > or =65 years who have lost all their natural teeth (objective 13.4). Edentulism has been declining in the United States since the 1950s, but few state-specific data are available on adult tooth loss. To estimate the prevalence of edentulism among persons aged > or =65 years, CDC analyzed data from the 46 states that participated in the oral health module of the 1995-1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the findings from this analysis, which indicate a large state-specific variation in edentulism and that many states have not yet achieved the national health objective for preventing total tooth loss.     

Nonfatal self-inflicted injuries among adults aged > or = 65 years--United States, 2005

In 2005, an estimated 372,722 persons in the United States were treated in hospital emergency departments (EDs) for intentional, nonfatal self-inflicted injuries. Nonfatal self-inflicted injuries are most common among adolescents and young adults; few studies have investigated these types of injuries among adults aged > or =65 years. However, older adults are one of the fastest-growing population groups in the United States and can require more extensive and more costly medical treatment than younger adults. To characterize ED visits for nonfatal self-inflicted injuries among U.S. adults aged > or =65 years, CDC analyzed ED visits for 2005 using data from the National Electronic Injury Surveillance System All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, in 2005, adults aged > or =65 years made an estimated 7,105 visits to EDs (i.e., 19.3 visits per 100,000 population) for nonfatal self-inflicted injuries, and ED health-care providers attributed 80.4% of these visits to suicidal behavior. In addition, a significantly higher percentage of adults aged > or =65 years compared with younger adults were hospitalized after ED visits for suicidal behavior. Comprehensive prevention strategies that combine community outreach, crisis intervention, and clinical management are needed to decrease morbidity and mortality from suicidal behavior among older adults.     

Mobility limitation among persons aged > or =40 years with and without diagnosed diabetes and lower extremity disease--United States, 1999-2002

Diabetes increases the risk for mobility limitation, especially among older persons. Lower extremity disease (LED), which includes peripheral arterial disease (PAD) and peripheral neuropathy (PN), also increases the risk for mobility limitation. To assess the prevalence of mobility limitation among persons with diagnosed diabetes, persons with LED, and persons with both or neither condition, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 for adults aged > or =40 years. This report summarizes the preliminary findings, which indicated that the national prevalence of mobility limitation is higher among persons with either diagnosed diabetes or LED than those without the conditions, and that adults with both conditions have a higher prevalence of mobility limitation than those with either condition alone. Monitoring the prevalence of diabetes, LED, and associated risk factors and identifying effective LED prevention strategies will help reduce the burden of mobility limitation in the United States.     

Influenza and pneumococcal vaccination of adults aged > or = 65: racial/ethnic differences

BACKGROUND: Influenza and pneumococcal polysaccharide vaccination (PPV) rates among persons aged > or = 65 years are significantly below national objectives of 90%, particularly among blacks and Hispanics. This study of the 2002-2003 influenza season examines factors that may be associated with low coverage. METHODS: A national sample of 1839 community-dwelling adults aged > or = 65 years was surveyed by telephone during January-May 2003. Outcomes analyzed in 2004-2005 included self-reported influenza vaccination and PPV; place of vaccination; and among the unvaccinated, main reasons for nonvaccination, awareness of vaccination, and receipt of provider recommendation for vaccination. RESULTS: Influenza vaccine coverage was 67.8%, and PPV coverage was 60%. Coverage among blacks and Hispanics was > or = 15 percentage points below that of whites. Half (52%) of persons who had not received PPV were aware it was recommended for persons their age, and < 10% had received a recent physician recommendation for PPV. Concern about side effects and not thinking that they needed the vaccine were the most frequently cited reasons for not receiving an influenza vaccination. In each racial/ethnic group, prevalence of potential missed opportunities (recent doctor visit, but no vaccine recommendation from provider and no influenza vaccination) was higher than prevalence of potential vaccine refusal (recent doctor visit and vaccine recommendation from provider, but no vaccine): blacks, 26.9% versus 7.9%; Hispanics, 19.9% versus 12.1%; and white non-Hispanics, 16.2% versus 6.1%. CONCLUSIONS: Improved adherence to vaccination guidelines by healthcare providers could substantially raise coverage in all racial/ethnic groups. Multiple factors contribute to racial/ethnic disparities, and their relative contributions should be further quantified.     

Colorectal cancer test use among persons aged > or = 50 years--United States, 2001

Colorectal cancer is the second leading cause of cancer-related death in the United States. The lifetime risk for having colorectal cancer diagnosed is 6%. Screening measures decrease the incidence and mortality of colorectal cancer by detecting early disease and removing precancerous lesions. The U.S. Preventive Services Task Force recommends routine cancer screening for U.S. adults aged > or = 50 years with one or a combination of the following screening options: annual home fecal occult blood testing (FOBT), sigmoidoscopy every 5 years, colonoscopy every 10 years, or double contrast barium enema every 5 years. To estimate rates and evaluate trends for colorectal cancer test use among U.S. adults aged > or = 50 years, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) on the use of FOBT and sigmoidoscopy/colonoscopy and compared the data for 2001 with those for 1997 and 1999. This report summarizes the results of that analysis, which indicate that despite small increases in the self-reported use of colorectal cancer tests, screening rates remain low. Efforts to increase awareness and encourage regular colorectal cancer screening should continue.     

Advance directives in nursing home residents aged > or =65 years: United States 2004

In 1996, 53% of US nursing home residents had advance directives. This report defines documentation of advance directives in a nationally representative survey of US nursing home residents aged !65 years in 2004, as well as advance directive use in relation to demographic factors and receipt of specialty services including hospice/palliative care. In 2004, advance directives were documented in 69.9% of US nursing home residents aged !65 years and in 93.6% of residents receiving hospice/palliative care. Documentation of advance directives increased substantially between 1996 and 2004 and is nearly universal among residents receiving hospice/palliative care services. However in 2004, 3 of every 10 US nursing home residents did not have documentation of advance care plans. Continued efforts are needed to promote the importance of advance care planning among US nursing home residents.     

Influenza vaccination coverage among persons with asthma--United States, 2005-06 influenza season

During 2006, approximately 6.8 million (9.3%) U.S. children and 16.1 million (7.3%) U.S. adults were reported to have asthma. Since 1964, the Advisory Committee on Immunization Practices (ACIP) has recommended influenza vaccination of all persons with asthma because of the higher risk for medical complications from influenza for those persons. Influenza vaccination coverage of persons with asthma varies by age group and remains below Healthy People 2010 targets of 60% coverage of persons aged 18--64 years with high-risk conditions (14-29 c) and 90% of all persons aged > or =65 years (14-29 a). Influenza vaccination rates of children and older adults with asthma have not been well studied. Using 2006 National Health Interview Survey (NHIS) data, this report provides the first examination of influenza vaccination rates and related factors across a national sample of persons with asthma aged > or =2 years. The results indicated that 36.2% received influenza vaccination during the 2005--06 influenza season. Vaccination rates remained below target levels among all subgroups examined, including those reporting the greatest number of health-care visits in the past 12 months. The results of this study indicate that influenza vaccination coverage of all persons with asthma can be improved by increasing access to health care and using opportunities for vaccination during health-care visits.     

Influenza and pneumococcal vaccine coverage among a random sample of hospitalised persons aged 65 years or more, Victoria

This study was undertaken to assess the uptake of influenza and pneumococcal vaccination based on provider records of the hospitalised elderly, a group at high risk of influenza and pneumococcal disease. The study used a random sample of 3,204 admissions at two Victorian teaching hospitals for patients, aged 65 years or more who were discharged between 1 April 2000 and 31 March 2002. Information on whether the patient had received an influenza vaccination within the year prior to admission or pneumococcal vaccination within the previous five years was ascertained from the patient's nominated medical practitioner/vaccine provider. Vaccination records were obtained from providers for 82 per cent (2,804/2,934) of eligible subjects. Influenza vaccine coverage was 70.9 per cent (95% CI 68.9-72.9), pneumococcal coverage was 52.6 per cent (95% CI 50.4-54.8) and 46.6 per cent (95% CI 44.4-48.8) had received both vaccines. Coverage for each vaccine increased seven per cent over the two study years. For pneumococcal vaccination, there was a marked increase in 1998 coinciding with the introduction of Victoria's publicly funded program. Influenza and pneumococcal vaccine coverage in eligible hospitalised adults was similar to, but did not exceed, estimates in the general elderly population. Pneumococcal vaccination coverage reflected the availability of vaccine through Victoria's publicly funded program. A nationally funded pneumococcal vaccination program for the elderly, as announced recently, should improve coverage. However, these data highlight the need for greater awareness of pneumococcal vaccine among practitioners and for systematic recording of vaccination status, as many of these subjects will soon become eligible for revaccination.     

Influenza vaccination: the persuasiveness of messages among people aged 65 years and older

About 90% of all influenza-related deaths occur among people aged 65 years and older. Vaccination remains the primary option for preventing influenza infection. This study examined the efficacy of messages designed to increase the uptake of influenza vaccination. Two messages, narrative and didactic, were created based on the Extended Parallel Process Model (EPPM). The study employed a one-factor between-subjects experimental design with participants assigned randomly to three conditions: no message, didactic communication, and narrative communication. Participants were 311 Italian people aged 65 years or older. The results showed that, compared to no message and didactic communication, narrative communication was related to higher risk perception of influenza, to higher perception of the efficacy of the vaccine, and to self-efficacy related to vaccination, controlling for social trust, previous flu shot, and demographic variables. There were no differences among the three conditions with respect to the intention to receive the influenza vaccine. Findings suggest that narrative communication based on EPPM may have a persuasive effect on people aged 65 years or older.