# Presentation: 370590

## Highlights of Recent Results from the New Health Insurance Modulesof the National Immunization Survey

- National Vaccine Advisory Committee
- October 22, 2007
- Philip J. Smith, PhD
- Immunization Services Division
- NCIRD/CDC

**Notes:**
Hello. I’m honored to be here today to talk to your about Highlights on insurance results from the National Immunization Survey. Toward the end of my talk I’ll show those results for both 19-35 month old children and for 13-17 year old teenagers.

## 2001-2002 HIM Research topics

- The association between having a medical home and vaccination coverage among children eligible for the Vaccines for Children (VFC) program.
- VFC eligible children who have a medical home and use it consistently to receive all vaccine doses can have vx coverage rates that are comparable to non-VFC children.
- 	(4:3:1:3:3: 75.3% vs 77.7%, adjusted p<0.05)
- 	(Smith et al. *Pediatrics* 2005).

**Notes:**
One research topic we investigated using this data was looking at the a association between having a medical home and vaccination coverage among children eligible for the Vaccines for Children Program.

Results from that investigation showed that VFC eligible children who have a medical home and use it consistently to receive all vaccine doses can have vx coverage rates that are comparable to non-VFC children living in more affluent households. Quite a success story!

## 2001-2002 HIM Research topics 

- Associations between childhood vaccination coverage, insurance type, and breaks in health insurance coverage. (Smith et al. *Pediatrics* 2006).
- 						                      _4:3:1:3:3*_
- 1. 	Privately, only, insured 				75.6%(r)
- 	Publicly insured 					70.0%**
- 	Uninsured 						52.6%**
- 2. 	No breaks  in health insurance coverage 		73.5%(r)
- 	Currently insured, but had breaks		             64.8%**
- 	Currently uninsured, but previously insured 		53.3%**
- 	Chronically uninsured 				47.4%**
- Among 19-24 month-old children
- (r) = reference category
- ** significantly different at 0.05 level compared to the reference category

**Notes:**
IN other research we looked at Associations between childhood vaccination coverage, insurance type, and breaks in health insurance coverage.

Results from that study confirmed that children who were insured with public insurance or were uninsured were significantly less-well vaccinated than children covered by private insurance. You can see the gradient in 4:3:1:33 in this first table that shows this from our data.

In the second table we show results from the same study that showed that children who were covered by health insurance at the time of the NIS RDD interview and who had no breaks in health insurance coverage were significantly better vaccinated than children who were currently insured, but had breaks in coverage, children who were currently uninsured but previously insured, and children who never were insured.

## Insurance and 4:3:1 Coverage at 19 months of Age2006 NIS

|  | Insurance Status |  |
| --- | --- | --- |
|  | Uninsured | Insured |
| Family Income category | % (95% CI) | % (95% CI) |
| ≤ 133% FPL |  57.8 (±6.9 ) |  63.7 (±2.1 )* |
| 134% -399% FPL |  60.6 (±7.5 ) |  67.9 (±1.9 )* |
| ≥ 400% FPL |  56.7 (±18.3) |  75.3 (±2.1 )* |

- * = p<0.05

**Notes:**
With respect to the association between vx coverage and being covered by health insurance, this slide shows the differences in timely vx coverage with the 4:3:1 series by 19 months of age for uninsured and insured children, stratified by family income.

These results show that for each level of family income, children who are covered by health insurance have significantly better timely 4:3:1 coverage than children who are not covered by health insurance.

## To what extent would the % VFC-eligible children increase if underinsured receiving doses at public facilities were VFC-eligible?

- VFC, 4 categories	48.0%
- VFC, 5 categories	49.1%

**Notes:**
Some researchers want to know about the extent to which the % VFC-eligible children would increase if VFC were expanded to include underinsured receiving doses at public facilities increase? Currently, our analysis shows that the increase would be slight: from approximately 48% to 49%.

## Estimated MMR Coverage13-17 Year Old Teens: 2006

|  | 2006
%    (95% CI) |
| --- | --- |
| VFC eligible | 83.4%  ±3.3% |
| On Medicaid | 83.0%  ±4.0% |
| Uninsured** | 84.2%  ±6.9% |
| AI/AN | 79.3%  ±11.4% |
| Underinsured/FQHC | 94.1%  ±8.7% |

- ** = at the time of the NIS RDD interview

**Notes:**
This table shows the estimated coverage rate of the MMR vaccine among 13-17 year old teens. The rate is fairly uniform accoss all 4 levels of VFC eligiblility, with the exception of the underinsured receiving doses at an fqhc, which is high.