Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for Change
Understanding trends in vaccine refusal is critical to monitor as small declines in vaccination coverage can lead to outbreaks of vaccine-preventable diseases. Using electronic heath record (EHR) data from the Children’s Hospital of Philadelphia’s 31 outpatient primary care sites, we created a cohor...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Vaccines |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2076-393X/10/10/1688 |
| _version_ | 1827647817246572544 |
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| author | Angela K. Shen Robert W. Grundmeier Jeremey J. Michel |
| author_facet | Angela K. Shen Robert W. Grundmeier Jeremey J. Michel |
| author_sort | Angela K. Shen |
| collection | DOAJ |
| description | Understanding trends in vaccine refusal is critical to monitor as small declines in vaccination coverage can lead to outbreaks of vaccine-preventable diseases. Using electronic heath record (EHR) data from the Children’s Hospital of Philadelphia’s 31 outpatient primary care sites, we created a cohort of 403,448 children less than age 20 years who received at least one visit from 1 January 2013 through 31 December 2020. The sample represented 1,449,061 annualized patient and 181,131 annualized preventive vaccination visits per year. We characterized trends in vaccine refusal and acceptance using a repeated cross-sectional observational analysis of electronic health records (EHR) data using a single annual merged observation measure for patients seen multiple times for preventive healthcare within a calendar year. Refusals were identified for 212,900 annualized patient-visit year observations, which represented 14.6% of annualized patient-visit year observations and 25.1% of annualized vaccine patient-year observations. The odds of having a refusal marker were significantly increased in patients seen in suburban practices (aOR [CI]: 2.35 [2.30–2.40, <i>p</i> < 0.001]), in patients with increased age 11–17 years (aOR [CI]: 3.85 [3.79–3.91], <i>p</i> < 0.001), and those eligible for the VFC program (aOR [CI]: 1.10 [1.08–1.11]. Parental refusal (61.0%) and provider decisions (32.0%) were the most common documented in progress notes for not administering vaccines, whereas contraindications (2.5%) and supply issues (1.8%) were the least common. When offered, vaccine acceptance increased for human papillomavirus, hepatitis B, measles-mumps-rubella-containing and varicella-containing vaccines and decreased for hepatitis A and meningococcal vaccines. Repeated offering of vaccines was central to increasing acceptance, in part due to increased opportunities to address specific concerns. |
| first_indexed | 2024-03-09T19:23:56Z |
| format | Article |
| id | doaj.art-5ed96777a2594a02a7ff18d8a23716f1 |
| institution | Directory Open Access Journal |
| issn | 2076-393X |
| language | English |
| last_indexed | 2024-03-09T19:23:56Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Vaccines |
| spelling | doaj.art-5ed96777a2594a02a7ff18d8a23716f12023-11-24T03:04:18ZengMDPI AGVaccines2076-393X2022-10-011010168810.3390/vaccines10101688Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for ChangeAngela K. Shen0Robert W. Grundmeier1Jeremey J. Michel2Vaccine Education Center, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USADepartment of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19146, USADepartment of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19146, USAUnderstanding trends in vaccine refusal is critical to monitor as small declines in vaccination coverage can lead to outbreaks of vaccine-preventable diseases. Using electronic heath record (EHR) data from the Children’s Hospital of Philadelphia’s 31 outpatient primary care sites, we created a cohort of 403,448 children less than age 20 years who received at least one visit from 1 January 2013 through 31 December 2020. The sample represented 1,449,061 annualized patient and 181,131 annualized preventive vaccination visits per year. We characterized trends in vaccine refusal and acceptance using a repeated cross-sectional observational analysis of electronic health records (EHR) data using a single annual merged observation measure for patients seen multiple times for preventive healthcare within a calendar year. Refusals were identified for 212,900 annualized patient-visit year observations, which represented 14.6% of annualized patient-visit year observations and 25.1% of annualized vaccine patient-year observations. The odds of having a refusal marker were significantly increased in patients seen in suburban practices (aOR [CI]: 2.35 [2.30–2.40, <i>p</i> < 0.001]), in patients with increased age 11–17 years (aOR [CI]: 3.85 [3.79–3.91], <i>p</i> < 0.001), and those eligible for the VFC program (aOR [CI]: 1.10 [1.08–1.11]. Parental refusal (61.0%) and provider decisions (32.0%) were the most common documented in progress notes for not administering vaccines, whereas contraindications (2.5%) and supply issues (1.8%) were the least common. When offered, vaccine acceptance increased for human papillomavirus, hepatitis B, measles-mumps-rubella-containing and varicella-containing vaccines and decreased for hepatitis A and meningococcal vaccines. Repeated offering of vaccines was central to increasing acceptance, in part due to increased opportunities to address specific concerns.https://www.mdpi.com/2076-393X/10/10/1688vaccine refusalvaccine acceptancevaccine hesitancy |
| spellingShingle | Angela K. Shen Robert W. Grundmeier Jeremey J. Michel Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for Change Vaccines vaccine refusal vaccine acceptance vaccine hesitancy |
| title | Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for Change |
| title_full | Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for Change |
| title_fullStr | Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for Change |
| title_full_unstemmed | Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for Change |
| title_short | Trends in Vaccine Refusal and Acceptance Using Electronic Health Records from a Large Pediatric Hospital Network, 2013–2020: Strategies for Change |
| title_sort | trends in vaccine refusal and acceptance using electronic health records from a large pediatric hospital network 2013 2020 strategies for change |
| topic | vaccine refusal vaccine acceptance vaccine hesitancy |
| url | https://www.mdpi.com/2076-393X/10/10/1688 |
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