What Impacts Adult Vaccination?


Adult vaccine uptake lags and understanding the reasons could be important.

Vaccination is important to promote health over the course of a person’s life. However, vaccine uptake in adults remains relatively low. Research presented at IDWeek 2022, held October 19 to 23 in Washington, DC, evaluated what state-level variables might impact adult vaccination coverage rates for influenza, tetanus, herpes zoster, and pneumococcal vaccines over time.

Investigators conducted a retrospective database analysis of the 2011-2019 Behavioral Risk Factor Surveillance System to determine the state-level vaccination coverage rates of adults aged 18 to 64 years. Systematic variable selection was used to find state-level variables that were linked to increased in vaccine coverage in adults.

Five variables were identified via multivariable regression models: Medicaid expansion status, accountable care organizations in place, health homes program, percentage of adults who reported going more than 12 months without seeing a health care provider due to cost, and percentage of adults who self-reported participation in any form of physical activity.

No state-level variable was significantly tied to increased uptake of the tetanus vaccine. For influenza, the percentage of adults reporting any degree of physical activity was found to be significantly tied to changes in vaccination coverage (P =.01). The percentage of adults who hadn’t visited a doctor in the past 12 months due to cost was significantly associated with pneumococcal vaccination (P =.02). Both activity (P =.01) and not seeing a physician (marginally significant, P =.056) were linked to herpes zoster uptake, as well as health homes (P =.04).

Although few state-level variables had an association with changes in vaccination coverage rate, some showed a significant link. The researchers did note that the variables may not directly be tied to vaccination, but rather “may be associated with public health infrastructure supporting vaccination ecosystems.” More research on the subject is currently being conducted.


1. Eiden A, Hunter S, Garbinsky D, et al. Identification of state-level variables associated with changes in vaccination coverage rates in adults aged 18 to 64 in the US. Presented at: IDWeek 2022; October 19-23, 2022; Washington, DC. Poster 107.

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