Infectious Disease
The association between health care access and shingles vaccination among older adults in Virginia, United States Chidozie Declan Iwu* Chidozie Declan Iwu Pramita Shrestha Miguel Martinez Alyson J Littman Julia Hood
Introduction: Shingles is a debilitating vaccine preventable disease that poses a health threat to older adults. Two vaccines against shingles have been approved and recommended for adults 50+ years old in the United Sates. This study aimed to assess the association between healthcare access and shingles vaccination among older adults, as well as the impact of COVID-19 pandemic on vaccine uptake.
Methods: This was a cross-sectional study among 50+ years adults in Virginia (n=16,576) using data from the Behavioral Risk Factor Surveillance System (2018, 2019, and 2020). We calculated unweighted prevalence of shingles vaccination by health insurance and access to primary health care provider (used as proxies for health care access) and in relation to the COVID-19 pandemic (pre vs. during). Log binomial regression models were used to estimate weighted prevalence ratios (PR), adjusting for potential confounders.
Results: Shingles vaccination was substantially higher among those with healthcare access compared to those without. Specifically, shingles vaccination was 40% among those with health insurance vs. 12% among those without, and 41% among those with a primary healthcare provider vs 18% among those without. Shingles vaccination was 47% during the COVID-19 pandemic vs. 36% before. People with health insurance [adjusted PR (aPR): 2.03 (95% CI: 1.44 – 2.86)], and access to primary health care provider [aPR: 1.99 (95% CI: 1.65 – 2.41)] were approximately twice as likely to receive shingles vaccine compared to those without health insurance and access to primary health care provider. There was 26% higher likelihood of receiving the shingles vaccine during the pandemic compared to pre-pandemic [aPR:1.26 (95% CI: 1.20 – 1.33)].
Conclusion: This study highlights the pivotal role of health care access on shingles vaccine uptake among older adults. The observed rise in vaccine prevalence during the pandemic reinforces the role of public health initiatives and awareness in vaccine uptake.