Less than 10% of Medicaid patients with lupus are vaccinated against preventable diseases

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The researchers report funding from the NIH. Feldman reports on research support from Pfizer and unpaid positions on the Board of Directors of the American College of Rheumatology and the Medical-Scientific Advisory Council of the Lupus Foundation of America.

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Less than 10% of Medicaid recipients with systemic lupus erythematosus are vaccinated against preventable diseases such as flu, herpes zoster, cervical cancer, and others, according to data published in Arthritis Care & Research.

“Previous studies in people with SLE have shown high rates of serious infections and significant associated mortality,” Candace H. Feldman, MD, ScD, of Brigham and Women’s Hospital in Boston and colleagues. “Herpes zoster hospitalization rates in this population are particularly high and may rise. In addition, individuals with SLE and other systemic rheumatic diseases may be at higher risk of high-grade cervical dysplasia and cervical cancer compared to the general population, which may be related in part to the persistence of human papillomavirus infection. ”

Less than 10% of Medicaid recipients with SLE are vaccinated against preventable diseases such as flu, herpes zoster, cervical cancer, and others, according to data from Feldman CH et al. Arthritis Care Res. 2021; doi: 10.1002 / acr.24628.

“In general, vaccinations for these conditions have been shown to be safe and effective in people with SLE,” they added. “While decreased immunogenicity has sometimes been suggested with immunosuppressant use, in most cases the vaccines still appear to be effective. Nevertheless, the vaccination rates for influenza, pneumococci and human papillomaviruses in people with systemic rheumatic diseases remain suboptimal. “

To analyze acute care uptake for vaccine-preventable diseases and their sociodemographic factors and predictors in patients with SLE, Feldman and colleagues examined Medicaid claims data from 29 states from 2000 to 2010. The researchers included a total of 45,654 adult benefit recipients with prevalence disease SLE and 12 months Enrolled before your first lupus code.

Candace H. Feldman

The mean age of the patients included was 41 years and 93% were women. In addition, 40% were Black, 38% White, 16% Hispanic, 3% Asian, and 1% Native American or Alaskan, while 3% reported more than one race. In terms of geographic distribution, 20% of the included beneficiaries were from the Midwest, 21% from the Northeast, 38% from the South and 21% from the West.

Researchers identified the use of acute care through ED or hospital discharge diagnoses and defined vaccine-preventable diseases as influenza, pneumococcal disease, meningococcal disease, herpes zoster, high-grade cervical dysplasia, cervical cancer, or hepatitis B. Using this data, they searched for examples of use in acute care for vaccine-preventable diseases according to the patient’s first SLE code, using Cox regression to calculate risk based on sociodemographic factors and health care, adjusting vaccinations, comorbidities and medication.

According to the researchers, less than 10% of enrolled beneficiaries received vaccinations. The highest vaccination rate – 7.2% per year – was achieved with the flu vaccine, while all other vaccines did not reach 3% during the 12 month period. In total, there were 1,290 patients with at least one emergency room visit or hospitalization for a vaccine-preventable disease, at a rate of 6.6 per 1,000 person-years, with 93% of the cases occurring in those who were not vaccinated. The risk of acute care for a vaccine-preventable disease was 22% higher in black patients compared to white patients (HR = 1.22; 95% CI 1.06-1.39).

In addition, those with more outpatient visits showed a lower risk of acute care for vaccine-preventable diseases with a hazard ratio of 0.74 (95% CI, 0.61-0.91) for 6 to 10 visits compared to none and 0, 67 (95% CI, 0.55-0.82) for more than 10 visits compared to none.

“Between 2000 and 2010, we identified 1,290 patients receiving acute care for vaccine-preventable diseases, 93% of which were in patients with no prior vaccination billing codes,” Feldman told Healio Rheumatology. “We also found that black patients were 22% more likely to have these diseases in acute care than white patients.”

“More outpatient use was associated with a significantly lower risk,” she added. “These episodes show potentially missed opportunities, especially among vulnerable population groups, to ensure high-quality outpatient care, and provide impetus for further interventions to address this problem.”

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