Type of GI Provider Does Not Affect Rates of Vaccination Amongst Inflammatory Bowel Disease Patients

Type of GI Provider Does Not Affect Rates of Vaccination Amongst Inflammatory Bowel Disease Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Type of GI Provider Does Not Affect Rates of Vaccination Amongst Inflammatory Bowel Disease Patients Mehul Trivedi, Neena Malik, Joann Kwah This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-148514/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background: Patients with Inflammatory Bowel Disease (IBD) are at heightened risk of infection, and are often under vaccinated. At our institution, IBD patients may follow up with one of three gastroenterology (GI) providers: IBD specialists, GI Fellows and General GI providers. Aims: Our primary objective was to identify whether the type of GI provider had an effect on rates of vaccinations for IBD patients. The seven vaccines studied were listed in the American College of Gastroenterology’s 2017 Guidelines on Preventative Care in IBD, and include Influenza, Tetanus/Diphtheria/Pertussis, Hepatitis A (HAV), Hepatitis B (HBV), Pneumococcus (PCV13 and PPSV23), Meningococcus, and Human Papillomavirus (HPV). Methods: Retrospective case control study of IBD patients, looking at vaccination rates for each of the seven vaccinations listed above, and type of GI provider followed. Other data collected included patient demographics, IBD type, treatment regimen and insurance. Results: Of 338 IBD patients, 65 (19.2%) followed up with a GI fellow, 110 (32.5%) with a general GI provider, and 163 (48.2%) with an IBD specialist. HBV was the only vaccine with a significant difference in vaccination rate by type of provider. Bivariate analysis showed that patients who followed with IBD specialists and GI fellows were more likely to be vaccinated for HBV than patients who followed up with general GI provider (OR = 2.55, p = .003 and OR = 2.73, p = .007 respectively). Conclusion Type of GI provider only impacted rates of vaccination for HBV among IBD patients in this study, with IBD specialists and GI fellows outperforming general GI providers. Gastroenterology & Hepatology IBD Vaccinations GI providers IBD specialists GI Fellows General Gastroenterologists Introduction Inflammatory Bowel Disease (IBD) is an inflammatory condition with an increasing incidence and prevalence throughout the world [ 1 ]. The pathogenesis of IBD, while not completely understood, is thought to involve a dysregulated immune response to gut flora, as well as environmental factors that promote intestinal inflammation [ 2 ]. Due to this inflammation, IBD patients often face the prospect of long-term immunosuppressive therapy in order to control their symptoms. As a result, serious or opportunistic infections can pose a problem for this patient population [ 3 ]. Many of these infections can be preventable through regular vaccination, however the literature shows that IBD patients have suboptimal rates of vaccination, in most cases, lower than non-IBD patients [ 4 ]. The reason behind the lower vaccination rate is likely multifactorial, but one possibility may be due to whom the patient identifies as their primary provider. Patients with IBD are likely to follow up with both a gastroenterology (GI) provider and a primary care physician (PCP), but most, if not all will see their GI provider more often [ 5 ]. This close relationship may lead to patients treating their GI provider as their PCP, leading to confusion over whose responsibility it is to vaccinate IBD patients [ 6 ]. There is data that shows that many GI providers are less likely to vaccinate patients than PCPs and are less aware of the appropriate immunizations for IBD patients [ 7 – 9 ]. As a result, IBD patients often miss opportunities to receive necessary vaccines [ 10 ]. To address the under vaccination of IBD patients, the American College of Gastroenterology (ACG) published clinical guidelines in 2017 with the goal of increasing awareness of this issue among GI providers [ 11 ]. These guidelines represent the first official set of recommendations for the vaccination of IBD patients, an important step towards educating GI providers about the importance of vaccinating this distinct patient population. Many factors have been shown to contribute to differences in vaccine rates, including insurance status, income, education level and the presence of preexisting conditions such as IBD [ 12 ]. Studies have also examined vaccine-specific differences among IBD patients, but no study has sought to examine the effect that the specific type of GI provider has on vaccination rates of IBD patients. The objective of this study is to identify whether there are differences in vaccination rates among IBD patients who follow up with these three different types of GI providers: IBD specialist, GI fellow, and general GI provider. We also aim to examine other factors that may influence the vaccination rates of IBD patients, including age, race, sex, type of IBD diagnosis, immunosuppression status, and socioeconomic factors such as insurance status. Methods We performed a retrospective case-control study of vaccination rates in IBD patients who followed at the Montefiore Medical Center (Bronx, NY) with either an IBD specialist, a GI fellow, or a general GI provider. Patient Selection Our study utilized Clinical Looking Glass (CLG), a proprietary software used at Montefiore that assists in searching through patient records, to create a database of patients with a confirmed diagnosis of IBD who followed up with a GI provider at the institution. Patients were identified by searching for those with an ICD 9 diagnosis code of regional enteritis, idiopathic colitis or ulcerative colitis (555.1, 555.2, 555.9, 556.0-556.9). Inclusion criteria included (a) patients 18 years or older, (b) patients with an ICD 9 diagnosis listed above and (c) patients with a documented follow up visit with a GI provider at the institution between 1/1/18 and 12/31/19. Exclusion criteria included (a) patients younger than 18 years and (b) patients who have not followed up with a GI provider at the institution since 1/1/18. Study Outcomes The primary outcome assessed was whether patients were current on the following vaccines: Influenza, Tetanus/Diphtheria/Pertussis (TDaP), Hepatitis A (HAV), Hepatitis B (HBV), Pneumococcus (PCV13 and PPSV23), Meningococcus, and Human Papillomavirus (HPV). These vaccines represent the seven recommended inactivated vaccines in the ACG clinical guidelines for health maintenance in IBD patients. We also utilized guidelines published by the Advisory Committee on Immunization Practices (ACIP) to determine which patients were current on vaccinations [ 13 ]. Two vaccinations, Meningococcus and HPV, were recommended primarily for younger people, so for analysis, patients considered eligible for these vaccines had to be age 27 or younger. The remainder of the criteria that determined if a patient was current on a vaccine are listed in Table 1 . Table 1 ACIP guidelines for determining status of vaccinations Vaccine Guidelines Influenza Patients were considered current on Influenza if they were vaccinated for the 2019–2020 flu season (vaccines given as early as June 2019) TDaP Patients were considered current on TDaP if they had received a vaccination or booster shot within the last 10 years. Hepatitis A Patients were considered current for Hepatitis A if they had recent documented positive Hepatitis A IgG antibody titers. Hepatitis B Patients were considered current of Hepatitis B if they had recent documented positive Hepatitis B Surface antibody titers. Pneumococcus Patients were considered current for Pneumococcus if they received a dose of PCV13, followed by PPSV23 eight weeks to one year later. Patients were also considered current if they received a PPSV23 dose, followed by a PCV13 dose one year later. Patients who had received their first vaccination less than one year ago and who were currently awaiting a second were also considered to be current. Meningococcus Patients 27 years old and younger were considered current for Meningococcus if they had received a conjugate vaccine followed by a booster shot, or the serogroup B shot. HPV Patients 27 years old and younger were considered current for HPV if they had received three doses of the HPV vaccine within six months. Demographic and Clinical Data Chart review was conducted using the electronic medical record to gather demographic information about each patient who met criteria for the study (age, sex, race and type of insurance) as well as information about the disease and its management (type of IBD diagnosis, treatment regimen and type of GI provider followed). Finally, information regarding vaccination status was obtained (date and type of vaccination). Statistics Our initial database was exported from CLG to Excel, where data from chart review was added. Once collated, our spreadsheet was imported into IBM SPSS for Mac (Version 25.0. Armonk, NY). Categorical variables were coded numerically to streamline statistical analysis. The Shapiro-Wilk test was used to assess normal distribution in continuous descriptive variables (age). As age was not normally distributed, it was converted to a categorical variable using 60 as a cutoff in order to separate the cohort into a “young” and “elderly” age group. Univariate chi-squared and regression analysis was first done to assess for independent predictors that affected vaccination status for each of the seven vaccines that were studied. Bivariate logistic regression analysis was then done to identify significant variables that affected vaccination rates. Each model was adjusted for age, sex, race, type of GI provider, IBD diagnosis, immunosuppression status, and insurance. Statistically significant values were determined by a two-sided p value < 0.05. Results A total of 338 patients were diagnosed with IBD and followed up with a Montefiore GI provider between the dates of 1/1/2018 and 12/31/2019 (Table 2 ). The average age was 50.7 years. There were 180 (53.30%) male and 158 (46.70%) female patients. The most predominant race was Hispanic (36.10%), followed by Black (31.70%), White (29.0%), Asian (2.40%), and Other (0.80%). There were 165 (48.80%) patients who had a diagnosis of Crohn disease, 169 (50%) who had Ulcerative Colitis (UC), and 4 (1.20%) who had indeterminate colitis. There were 163 (48.30%) patients in this cohort who followed up with an IBD specialist, 110 (32.50%) who followed up with a general GI provider, and 65 (19.20%) who followed up with a GI fellow. The most predominant type of insurance in this cohort was private (51.48%), followed by Medicaid (24.85%) and Medicare (23.67%). There were 155 (45.86%) patients who were on immunosuppressive therapy (either biologic, immunosuppressant or a combination of both with or without steroids), 131 (38.76%) patients who were on non-biologic therapy (aminosalicylates or anti-diarrheals), and 52 (15.39%) patients who were not on any therapy. Of note, no patient in this cohort was on steroid monotherapy and any patient on steroids was also on either a biologic or immunomodulator. Table 2 Patient Characteristics Demographic # of Patients Percent Total Patients 338 Avg. Age (SD) 50.7 (18.0) Sex Male 180 53.3% Female 158 46.7% Race White 98 29.0% Black 107 31.7% Hispanic 122 36.1% Asian 8 2.4% Other 3 0.8% Type IBD Crohn’s 165 48.8% UC 169 50.0% Indeterminate 4 1.2% Type of GI Providers GI fellow 65 19.2% GI provider 110 32.5% IBD specialist 163 48.3% Insurance Private 174 51.5% Medicare 80 23.7% Medicaid 84 24.9% Immunosuppressive Regimen Biologic 118 34.9% Immunomodulator Therapy 28 8.3% Combination therapy (Biologic + Immunomodulator) 9 2.7% Non-Biologic Therapy 131 38.8% None 52 15.4% Overall, 115 (34.0%) patients in this cohort were up to date with the Influenza vaccine (Table 3 ). There were 163 (48.2%) who were up to date with the TDaP vaccination, 74 (21.9%) who were up to date with the HAV vaccination, and 144 (42.6%) who were up to date with the HBV vaccination. There were 86 patients (25.4%) who received both Pneumococcus vaccines (both PCV13 and PPSV23), or were scheduled to receive a second Pneumococcus vaccination within the year of their first Pneumococcus vaccine. Current guidelines recommend that the Meningococcus and HPV vaccines be given to young patients, so for these vaccinations, only patients age 27 and under were considered. Out of a total of 50 patients in this age range, 22 (44.0%) were current on Neisseria and 13 (26.0%) on HPV (Table 4 ). Table 3 Demographic characteristics of patients current on vaccines Influenza TDaP Hep A Hep B Pneumococcus Demographics Current (%) P a Current (%) P Current (%) P Current (%) P Current (%) P Overall: 338 patients 155 (34.0%) 163 (48.2%) 74 (21.9%) 144 (42.6%) 86 (25.4%) Age < 60 66 (30.4%) 0.061 97 (44.7%) 0.082 54 (24.9%) 0.075 116 (53.5%) 0.0001 25 (11.5%) 0.0001 ≥ 60 49 (40.5%) 66 (54.5%) 20 (16.5%) 28 (23.1%) 61 (50.4%) Sex Male 49 (31.0%) 0.274 62 (39.2%) 0.002 33 (20.9%) 0.675 75 (47.5%) 0.09 33 (20.9%) 0.071 Female 66 (36.7%) 101 (56.1%) 41 (22.8%) 69 (38.2%) 53 (29.4%) Race White 29 (29.6%) 0.495 36 (36.7%) 0.009 10 (10.2%) 0.011 24 (24.5%) 0.0001 16 (16.3%) 0.003 Black 42 (39.3%) 62 (57.9%) 29 (27.1%) 56 (52.3%) 40 (37.4%) Hispanic 41 (33.6%) 62 (50.8%) 32 (26.2%) 56 (45.9%) 29 (23.8%) Other 3 (37.5%) 3 (27.3%) 3 (27.3%) 8 (72.7%) 1 (9.1%) GI Provider IBD Specialist 64 (39.3%) 0.119 78 (47.9%) 0.976 34 (20.9%) 0.137 85 (52.1%) 0.0001 38 (23.3%) 0.553 GI Fellow 17 (26.2%) 31 (47.7%) 20 (30.8%) 32 (49.2%) 16 (24.6%) General GI 34 (30.9%) 54 (49.1%) 20 (18.2%) 27 (24.5%) 32 (29.1%) IBD Diagnosis Crohn’s 67 (39.6%) 0.029 81 (47.9%) 0.913 39 (23.1%) 0.599 80 (47.2%) 0.078 48 (28.4%) 0.212 UC 48 (28.4%) 82 (48.5%) 35 (20.7%) 64 (37.9%) 38 (22.5%) Immunosuppression Yes 59 (38.1%) 0.149 64 (41.3%) 0.019 42 (27.1%) 0.033 82 (52.9%) 0.0001 44 (28.4%) 0.253 No 56 (30.6%) 99 (54.1%) 32 (17.5%) 62 (33.9%) 42 (23.0%) Insurance Private 56 (32.2%) 0.462 79 (45.2%) 0.285 40 (23.0%) 0.616 83 (47.7%) 0.051 32 (18.4%) 0.002 Public 59 (36.0%) 84 (51.2%) 34 (20.7%) 61 (37.2%) 54 (32.9%) a P-values represent univariate chi-squared analysis Table 4 Characteristics of patients current on age-dependent vaccines Neisseria HPV Demographic Current (%) P b Current (%) P Overall: 50 patients a 22 (44.0%) 13 (26.0%) Sex Male 16 (51.6%) 0.166 9 (47.4%) 0.007 Female 6 (31.6%) 4 (12.9%) Race White 6 (50.0%) 0.563 3 (25.0%) 0.801 Black 5 (38.5%) 3 (23.1%) Hispanic 11 (47.8%) 7 (30.4%) Other 0 0 GI Provider IBD Specialist 18 (48.6%) 0.340 9 (24.3%) 0.504 GI Fellow 4 (36.4%) 4 (36.4%) GI Provider 0 0 IBD Diagnosis Crohn’s 16 (42.1%) 0.631 7 (18.4%) 0.030 UC 6 (50.0%) 6 (50.0%) Immunosuppression Yes 20 (47.6%) 0.238 10 (23.8%) 0.418 No 2 (25.0%) 3 (37.5%) Insurance Private 13 (43.3%) 0.907 7 (23.3%) 0.418 Public 9 (45.0%) 6 (30.0%) a Patients between ages 18 and 27 were included in this cohort as these vaccines were age-dependent b P-values represent univariate chi-squared analysis Vaccination Status Univariate chi-squared analysis (Table 3 ) showed that patients with Crohn disease were more likely to be vaccinated for influenza than those with UC ( p = .029). For the TDaP vaccination, patients who were female, Black, Hispanic and immunocompetent were more likely to be vaccinated than male, White and immunosuppressed patients (p = .002, .009 and .019 respectively). For the HAV vaccination, patients who were Black, Hispanic and immunosuppressed were more likely to be vaccinated rather than White and immunocompetent patients (p = .011 and .033 respectively). For the HBV vaccination, patients were more likely to be vaccinated if they were younger than 60, Black, Hispanic, followed by IBD Specialists or GI Fellows, and if they were immunosuppressed when compared to patients older than 60, White, followed by a general GI and if they were immunocompetent (p = .0001 for all). For the pneumococcus vaccinations, patients older than 60, Black, Hispanic, and those with public insurance were more likely to be vaccinated than patients younger than 60, White and with private insurance (p = .0001, .003, .002 respectively). For the HPV vaccination, patients who were male and those with UC were more likely to be vaccinated than females and those with Crohn disease (p = .007 and .030 respectively) In bivariate logistical regression analysis (Table 5 ), some of the initial trends seen in univariate analysis did not persist. With influenza, age was the only significant factor with patients under the age of 60 being less likely to be up to date on their influenza vaccine than patients age 60 and above (OR = 0.55, p = 0.025). With the TDaP vaccination, sex, race and immunosuppression status persisted in their significance. Females were more likely to be up to date than males (OR = 1.65, p = 0.005), while Black (OR = 2.34, p = 0.004) and Hispanic (OR = 1.88, p = 0.033) patients were more likely to be up to date with TDaP than White patients. Patients on immunosuppressive therapy were less likely to be up to date than patients not on immunosuppression (OR = 0.53, p = 0.017). Table 5 Significant results of multivariate analysis OR 95% Confidence Interval P Influenza Age < 60 vs Age ≥60 0.55 0.33–0.93 0.025 TDaP Female vs Male 1.65 1.05–2.60 0.031 Black vs White 2.34 1.30–4.20 0.004 Hispanic vs White 1.88 1.05–3.36 0.033 Immunosuppression: Yes vs No 0.53 0.32–0.89 0.017 Hepatitis A Black vs White 3.15 1.42–6.99 0.005 Hispanic vs White 2.67 1.20–5.93 0.016 Hepatitis B Age < 60 vs Age ≥60 3.04 1.74–5.31 0.0001 Black vs White 4.39 2.26–8.51 0.0001 Hispanic vs White 2.68 1.40–5.11 0.003 Asian/Other vs White 8.03 1.83–35.2 0.006 IBD Provider vs General GI 2.55 1.38–4.72 0.003 GI Fellows vs General GI 2.73 1.32–5.68 0.007 Pneumococcus (PCV13 and PPSV23) Black vs White 3.85 1.77–8.39 0.001 Hispanic vs White 2.29 1.03–5.11 0.043 Ulcerative Colitis vs Crohn’s 0.52 0.28–0.99 0.045 Immunosuppression: Yes vs No 2.06 1.05–4.03 0.035 With the HAV vaccination, race was the only significant factor that persisted. Black (OR = 3.15, p = 0.005) and Hispanic (OR = 2.67, p = 0.016) patients were more likely to be up to date with the HAV vaccination than White patients. For the HBV vaccination, age, race and type of GI provider persisted in their significance. Patients under the age of 60 were more likely to be up to date with the HBV vaccination than patients 60 and older (OR = 3.04 p = 0.0001). Black (OR = 4.39, p = 0.0001), Hispanic (OR = 2.68, p = 0.003), and Asian/Other (OR = 8.03, p = 0.006) patients were all more likely to be up to date with the HBV vaccination than White patients. Patients who followed with an IBD provider (OR = 2.55, p = 0.003) or GI Fellow (OR = 2.73, p = 0.007) were more likely to be up to date with the HBV vaccination than patients who followed up with a general GI provider. For the pneumococcus vaccinations, race was the only factor that persisted in significance but type of IBD and immunosuppression status were significant in multivariate analysis. Black (OR = 3.85, p = 0.001) and Hispanic (OR = 2.29, p = 0.043) patients were more likely to be up to date, as compared to White patients. Patients with UC were less likely than patients with Crohn disease to be up to date on their pneumococcus vaccinations (OR = 0.52, p = 0.045). Patients on immunosuppression were more likely to be up to date than patients not on immunosuppression (OR = 2.06, p = 0.035). For Meningococcal and HPV vaccinations, no factors were found to be significant. Discussion Patients with IBD are at higher risk for certain serious infections which may be partly due to the use of immunosuppressive medication but also due to their underlying disease. Therefore, vaccinations in these patients are a critical part of their treatment plan, however rates of vaccinations in this patient population are lagging. This study is the first that examines the effect that type of GI provider plays on vaccination status in IBD patients. Focusing on seven inactivated vaccines recommended in the ACG clinical guidelines for preventive care in IBD patients, we performed an analysis of 338 IBD patients followed by GI providers at a single institution to see if type of GI provider affected vaccination status in IBD patients. The results showed that type of GI provider did not influence an IBD patient’s vaccination status for all but one of the seven inactivated vaccines. The HBV vaccination was the only vaccination where type of GI provider was significant for likelihood to be up to date with vaccination where IBD specialists and GI Fellows outperformed general GI providers. The significance of HBV specifically may be explained by the fact that IBD specialists may be more likely to prescribe immunosuppressive therapies such as a biologic or immunomodulator where immunization to HBV is considered standard of care prior to giving the medication. Also, insurers tend to request vaccination history including HBV status prior to approving the use of biologic, possibly contributing to the significant number of patients up to date with the HBV vaccination. GI Fellows also outperformed general GI providers as well, likely due to GI fellow supervision by IBD specialists when seeing IBD patients at this institution. Looking beyond type of provider, there were several other interesting observations in regards to vaccinations in this IBD patient population. Race played a significant role in vaccination rates in multivariate analysis for four of the vaccines studied (TDaP, HAV, HBV, and Pneumococcus). For each of these vaccines, Black and Hispanic patients were better vaccinated than White patients. These results were surprising, given that other studies on racial differences in vaccine administration typically found that Black and Hispanic patients had lower rates of vaccine coverage [ 14 , 15 ]. When comparing this cohort’s vaccination rates to the US national averages for these four vaccines, Black patients with IBD in this cohort were better vaccinated than Black Americans nationally (TDaP, HAV, HBV, and Pneumococcus rates of 57.9%, 27.1%, 52.3% and 37.4% in our cohort versus 51.1%, 10.2%, 27.0% and 34.2%) while White patients with IBD in this cohort were less likely to be vaccinated than White Americans nationally (TDaP, HAV, HBV, and Pneumococcus rates of 36.7%, 10.2%, 24.5% and 16.3% in our cohort versus 63.4%, 14.0%, 36.2% and 47.5%) [ 16 ]. These differences could be attributed to the work of the institution itself since it is located in the Bronx, New York, one of the most racially diverse counties in the United States. The institution is sensitive to health inequities and disparities in their patients and as a result, has expertise in handling health issues in these minority patients. Also, since IBD patients utilize the health care system more than the general population, this may have allowed for higher vaccination rates at an institution that is focused on minority health issues as a whole [ 17 ]. Age was another factor that played a role in rates of vaccination for Influenza and the HBV vaccination. IBD patients 60 and older were better vaccinated against Influenza, while IBD patients under 60 were better vaccinated for HBV. This data is consistent with national trends in vaccination seen in both the general population and IBD patients specifically, showing that that younger patients were more likely to be current with HBV vaccination status and less likely to be current on influenza when compared to older patients [ 16 , 18 ]. One reason for this trend could be due to enhanced influenza counselling by providers to older patients [ 19 ]. For the HBV vaccination, as it is typically indicated for high risk patients such as those with IBD, one reason to explain why younger patients are better vaccinated is that the incidence of IBD is greater in younger people, leading to rates of vaccination that skew towards the younger population [ 20 , 21 ]. Immunosuppressive therapy also played a role in vaccination status for TDaP and Pneumococcus vaccines. Immunosuppressed IBD patients had a lower rate of being vaccinated for TDaP and a higher rate of being vaccinated for pneumococcus. A reason for why this effect was seen may be because TDaP is more likely to be given to patients by their PCP, rather than their GI provider [ 7 ]. PCP’s are also less likely to immunize patients on immunosuppression, possibly explaining the negative effect immunosuppressive therapy had on TDaP [ 22 ]. Pneumococcus is primarily indicated for high risk patients (when under 65) such as those on immunosuppressive therapy. Given that this therapy is as an indication for the vaccine, it is likely that high-risk patients were better vaccinated due to the indication [ 23 ]. Finally, sex was seen to play a role in TDaP vaccination status, with women being more likely than men to be vaccinated. While there is no consistent data that supports this trend on a national level, a possible explanation for this is that ACIP guidelines since 2013 have recommended a TDaP shot for women during every pregnancy [ 24 ]. Pregnant women therefore may have led to better TDaP vaccination rates because of this additional opportunity to be vaccinated. This study had several limitations that are important to note. The first is related to the reliance on accuracy of data from one institution’s medical records. While efforts are made to update patient records to reflect care that was provided at outside institutions, it is possible that there were missed vaccinations if they were given elsewhere and not documented in the institution’s medical records. Another limitation is a lack of information as to what provider specifically ordered and administered vaccines. A GI provider may have requested a certain vaccination for their patient, however, if they were unable to administer it in their own practice it is out of their control whether or not a patient actually gets the requested vaccination. Finally, this study was unable to gather information on any reasons for why patients were not vaccinated. Previous studies have shown that patient anxiety plays a role in low vaccination rates among IBD patients, and it is possible that it played a role among this cohort as well [ 9 ]. Despite limitations, there were several strengths of this study including a large cohort of racially and socioeconomically diverse IBD patients following up at a single institution. Also, this study was the first to examine if differences in type of GI provider follow up affected vaccination rates. While type of GI provider may not influence the likelihood of vaccination, this study did show other factors that influenced vaccination rates specifically the effect of race. Black and Hispanic IBD patients were more likely to be vaccinated compared to White IBD patients for Tdap, the HAV vaccination, the HBV vaccination, and Pneumococcus vaccination, a finding which is not consistent with national vaccination rates amongst races. This may reflect more the work of the single institution that is located in a racially diverse county of New York and is focused on minority health issues. Future research should include efforts to better understand the effects of the institution itself on this finding or if there are other factors that shaped these results. Vaccination rates for the institution should be analyzed to compare with the IBD patients’ vaccination rates to see if this finding is consistent with the institution as a whole or just to the IBD patients at the institution. Despite the interesting findings regarding race, this study shows IBD patients at this institution still lag in receiving appropriate vaccinations. Future studies should be done to better understand IBD patients and all GI providers attitudes and knowledge of vaccinations, as well as assessing for any barriers to vaccinations. With this information, areas to explain gaps in vaccination can be identified and prospective studies can be designed to address these issues specifically in hopes of improving vaccination rates for these patients. Declarations Ethics Approval This study was approved by the Institutional Review Board at Albert Einstein College of Medicine and was deemed to be ethically conducted and carried out. Consent for Publication This study does not contain individual personal data, therefor consent for publication is not applicable. Availability of Data and Materials The datasets generated during and/or analyzed during the current study are not publicly available as they contain identifiable patient information and are stored on a secure hard drive. However, data can be de-identified and made available from the corresponding author on reasonable request. Competing Interests The authors declare they have no competing interests. Funding No outside sources of funding were acquired for this study. Author’s contribution MT collected, analyzed and interpreted patient data, as well as was a major contributor to writing the manuscript. 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Campaign, counseling and compliance with influenza vaccine among older persons. Clinics. 2011;66(12):2031–5. Benchimol EI, et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm Bowel Dis. 2014;20(10):1761–9. Cosnes J, et al. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1785–94. Selby L, Hoellein A, Wilson JF. Are primary care providers uncomfortable providing routine preventive care for inflammatory bowel disease patients? Dig Dis Sci. 2011;56(3):819–24. Vila-Corcoles A, et al. Pneumococcal vaccination coverages among low-, intermediate-, and high-risk adults in Catalonia. Hum Vaccin Immunother. 2016;12(11):2953–8. Fink AL, Klein SL. Sex and Gender Impact Immune Responses to Vaccines Among the Elderly. Physiology (Bethesda). 2015;30(6):408–16. Cite Share Download PDF Status: Under Review Version 1 posted Reviewer # 1 agreed at journal 08 May, 2021 Editor assigned by journal 12 Jan, 2021 Reviewers invited by journal 12 Jan, 2021 Submission checks completed at journal 12 Jan, 2021 Editor invited by journal 12 Jan, 2021 First submitted to journal 24 Dec, 2020 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-148514","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":8324723,"identity":"d1739d06-753b-4cce-b778-8b0fea3debef","order_by":0,"name":"Mehul Trivedi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYJCCAwwMzDz8DIcPPgByePgIqmeDapFsPJZsANLCRowWIGBmMDh8xkwCIYAH6M7vfXiYp8JahuHYsbTKrzl2MmwMzA8f3cCjxewYu8FhnjPpPIw9h4/dlt2WDHQYm7FxDl4tbAwHZ7Yd5mGWOJZ2W3IbM1ALD5s0YS3/DvOwyb8xK5bcVk+clgMfGw7z8DCcMWP8uO0wMVrSGA58OJbOI8FwLFmacdtxHjZmQn45fIz5Q0KNtb39gcMHP/7cVm3Pz9788DE+LSiAmQdMEqscBBh/kKJ6FIyCUTAKRgwAAOcFSGQbHRJYAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0003-0715-3686","institution":"UCSD: University of California San Diego","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mehul","middleName":"","lastName":"Trivedi","suffix":""},{"id":8324724,"identity":"1786efbc-ba71-471a-8362-2c8a35362419","order_by":1,"name":"Neena Malik","email":"","orcid":"","institution":"Montefiore Hospital and Medical Center: Montefiore Medical Center","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Neena","middleName":"","lastName":"Malik","suffix":""},{"id":8324725,"identity":"1bfaa3dc-40ca-4e14-ba4f-0be152c78a04","order_by":2,"name":"Joann Kwah","email":"","orcid":"","institution":"NYU Langone Medical Center: NYU Langone Health","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Joann","middleName":"","lastName":"Kwah","suffix":""}],"badges":[],"createdAt":"2021-01-15 16:42:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-148514/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-148514/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13650506,"identity":"5a09d965-1cde-40e0-850e-049030e284e3","added_by":"auto","created_at":"2021-09-17 09:41:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":285355,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-148514/v1/8654afe9-280e-4358-8008-cedbc906a6c7.pdf"}],"financialInterests":"","formattedTitle":"Type of GI Provider Does Not Affect Rates of Vaccination Amongst Inflammatory Bowel Disease Patients","fulltext":[{"header":"Introduction","content":" \u003cp\u003eInflammatory Bowel Disease (IBD) is an inflammatory condition with an increasing incidence and prevalence throughout the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The pathogenesis of IBD, while not completely understood, is thought to involve a dysregulated immune response to gut flora, as well as environmental factors that promote intestinal inflammation [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Due to this inflammation, IBD patients often face the prospect of long-term immunosuppressive therapy in order to control their symptoms. As a result, serious or opportunistic infections can pose a problem for this patient population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Many of these infections can be preventable through regular vaccination, however the literature shows that IBD patients have suboptimal rates of vaccination, in most cases, lower than non-IBD patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe reason behind the lower vaccination rate is likely multifactorial, but one possibility may be due to whom the patient identifies as their primary provider. Patients with IBD are likely to follow up with both a gastroenterology (GI) provider and a primary care physician (PCP), but most, if not all will see their GI provider more often [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This close relationship may lead to patients treating their GI provider as their PCP, leading to confusion over whose responsibility it is to vaccinate IBD patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. There is data that shows that many GI providers are less likely to vaccinate patients than PCPs and are less aware of the appropriate immunizations for IBD patients [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As a result, IBD patients often miss opportunities to receive necessary vaccines [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. To address the under vaccination of IBD patients, the American College of Gastroenterology (ACG) published clinical guidelines in 2017 with the goal of increasing awareness of this issue among GI providers [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These guidelines represent the first official set of recommendations for the vaccination of IBD patients, an important step towards educating GI providers about the importance of vaccinating this distinct patient population.\u003c/p\u003e \u003cp\u003eMany factors have been shown to contribute to differences in vaccine rates, including insurance status, income, education level and the presence of preexisting conditions such as IBD [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Studies have also examined vaccine-specific differences among IBD patients, but no study has sought to examine the effect that the specific type of GI provider has on vaccination rates of IBD patients.\u003c/p\u003e \u003cp\u003eThe objective of this study is to identify whether there are differences in vaccination rates among IBD patients who follow up with these three different types of GI providers: IBD specialist, GI fellow, and general GI provider. We also aim to examine other factors that may influence the vaccination rates of IBD patients, including age, race, sex, type of IBD diagnosis, immunosuppression status, and socioeconomic factors such as insurance status.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003eWe performed a retrospective case-control study of vaccination rates in IBD patients who followed at the Montefiore Medical Center (Bronx, NY) with either an IBD specialist, a GI fellow, or a general GI provider.\u003c/p\u003e \u003cp\u003ePatient Selection\u003c/p\u003e \u003cp\u003eOur study utilized Clinical Looking Glass (CLG), a proprietary software used at Montefiore that assists in searching through patient records, to create a database of patients with a confirmed diagnosis of IBD who followed up with a GI provider at the institution. Patients were identified by searching for those with an ICD 9 diagnosis code of regional enteritis, idiopathic colitis or ulcerative colitis (555.1, 555.2, 555.9, 556.0-556.9). Inclusion criteria included (a) patients 18\u0026nbsp;years or older, (b) patients with an ICD 9 diagnosis listed above and (c) patients with a documented follow up visit with a GI provider at the institution between 1/1/18 and 12/31/19. Exclusion criteria included (a) patients younger than 18\u0026nbsp;years and (b) patients who have not followed up with a GI provider at the institution since 1/1/18.\u003c/p\u003e \u003cp\u003eStudy Outcomes\u003c/p\u003e \u003cp\u003eThe primary outcome assessed was whether patients were current on the following vaccines: Influenza, Tetanus/Diphtheria/Pertussis (TDaP), Hepatitis A (HAV), Hepatitis B (HBV), Pneumococcus (PCV13 and PPSV23), Meningococcus, and Human Papillomavirus (HPV). These vaccines represent the seven recommended inactivated vaccines in the ACG clinical guidelines for health maintenance in IBD patients. We also utilized guidelines published by the Advisory Committee on Immunization Practices (ACIP) to determine which patients were current on vaccinations [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Two vaccinations, Meningococcus and HPV, were recommended primarily for younger people, so for analysis, patients considered eligible for these vaccines had to be age 27 or younger. The remainder of the criteria that determined if a patient was current on a vaccine are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eACIP guidelines for determining status of vaccinations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGuidelines\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfluenza\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients were considered current on Influenza if they were vaccinated for the 2019\u0026ndash;2020 flu season (vaccines given as early as June 2019)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTDaP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients were considered current on TDaP if they had received a vaccination or booster shot within the last 10\u0026nbsp;years.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients were considered current for Hepatitis A if they had recent documented positive Hepatitis A IgG antibody titers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHepatitis B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients were considered current of Hepatitis B if they had recent documented positive Hepatitis B Surface antibody titers.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients were considered current for Pneumococcus if they received a dose of PCV13, followed by PPSV23 eight weeks to one year later. Patients were also considered current if they received a PPSV23 dose, followed by a PCV13 dose one year later. Patients who had received their first vaccination less than one year ago and who were currently awaiting a second were also considered to be current.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeningococcus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients 27\u0026nbsp;years old and younger were considered current for Meningococcus if they had received a conjugate vaccine followed by a booster shot, or the serogroup B shot.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients 27\u0026nbsp;years old and younger were considered current for HPV if they had received three doses of the HPV vaccine within six months.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eDemographic and Clinical Data\u003c/p\u003e \u003cp\u003eChart review was conducted using the electronic medical record to gather demographic information about each patient who met criteria for the study (age, sex, race and type of insurance) as well as information about the disease and its management (type of IBD diagnosis, treatment regimen and type of GI provider followed). Finally, information regarding vaccination status was obtained (date and type of vaccination).\u003c/p\u003e \u003cp\u003eStatistics\u003c/p\u003e \u003cp\u003eOur initial database was exported from CLG to Excel, where data from chart review was added. Once collated, our spreadsheet was imported into IBM SPSS for Mac (Version 25.0. Armonk, NY). Categorical variables were coded numerically to streamline statistical analysis. The Shapiro-Wilk test was used to assess normal distribution in continuous descriptive variables (age). As age was not normally distributed, it was converted to a categorical variable using 60 as a cutoff in order to separate the cohort into a \u0026ldquo;young\u0026rdquo; and \u0026ldquo;elderly\u0026rdquo; age group.\u003c/p\u003e \u003cp\u003eUnivariate chi-squared and regression analysis was first done to assess for independent predictors that affected vaccination status for each of the seven vaccines that were studied.\u003c/p\u003e \u003cp\u003eBivariate logistic regression analysis was then done to identify significant variables that affected vaccination rates. Each model was adjusted for age, sex, race, type of GI provider, IBD diagnosis, immunosuppression status, and insurance. Statistically significant values were determined by a two-sided p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e "},{"header":"Results","content":" \u003cp\u003eA total of 338 patients were diagnosed with IBD and followed up with a Montefiore GI provider between the dates of 1/1/2018 and 12/31/2019 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The average age was 50.7\u0026nbsp;years. There were 180 (53.30%) male and 158 (46.70%) female patients. The most predominant race was Hispanic (36.10%), followed by Black (31.70%), White (29.0%), Asian (2.40%), and Other (0.80%). There were 165 (48.80%) patients who had a diagnosis of Crohn disease, 169 (50%) who had Ulcerative Colitis (UC), and 4 (1.20%) who had indeterminate colitis. There were 163 (48.30%) patients in this cohort who followed up with an IBD specialist, 110 (32.50%) who followed up with a general GI provider, and 65 (19.20%) who followed up with a GI fellow. The most predominant type of insurance in this cohort was private (51.48%), followed by Medicaid (24.85%) and Medicare (23.67%). There were 155 (45.86%) patients who were on immunosuppressive therapy (either biologic, immunosuppressant or a combination of both with or without steroids), 131 (38.76%) patients who were on non-biologic therapy (aminosalicylates or anti-diarrheals), and 52 (15.39%) patients who were not on any therapy. Of note, no patient in this cohort was on steroid monotherapy and any patient on steroids was also on either a biologic or immunomodulator.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e# of Patients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal Patients\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e338\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAvg. Age (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.7 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType IBD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrohn\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndeterminate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eType of GI Providers\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI fellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIBD specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e51.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunosuppressive Regimen\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBiologic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunomodulator Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCombination therapy (Biologic\u0026thinsp;+\u0026thinsp;Immunomodulator)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-Biologic Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOverall, 115 (34.0%) patients in this cohort were up to date with the Influenza vaccine (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There were 163 (48.2%) who were up to date with the TDaP vaccination, 74 (21.9%) who were up to date with the HAV vaccination, and 144 (42.6%) who were up to date with the HBV vaccination. There were 86 patients (25.4%) who received both Pneumococcus vaccines (both PCV13 and PPSV23), or were scheduled to receive a second Pneumococcus vaccination within the year of their first Pneumococcus vaccine. Current guidelines recommend that the Meningococcus and HPV vaccines be given to young patients, so for these vaccinations, only patients age 27 and under were considered. Out of a total of 50 patients in this age range, 22 (44.0%) were current on Neisseria and 13 (26.0%) on HPV (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of patients current on vaccines\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eInfluenza\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eTDaP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eHep A\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eHep B\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003ePneumococcus\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrent (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCurrent (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCurrent (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCurrent (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eCurrent (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall: 338 patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155 (34.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163 (48.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74 (21.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e144 (42.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e86 (25.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.061\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.082\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54 (24.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.075\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e116 (53.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e25 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (40.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (54.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e61 (50.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (31.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.274\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (39.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.675\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e75 (47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.09\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e33 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.071\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101 (56.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41 (22.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e69 (38.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e53 (29.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003e0.495\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (36.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003e0.009\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10 (10.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003e0.011\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e24 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003e0.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16 (16.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (57.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e56 (52.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e40 (37.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (33.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62 (50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e56 (45.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e29 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1 (9.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGI Provider\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIBD Specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (39.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.119\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (47.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.976\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (20.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.137\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e85 (52.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e38 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.553\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI Fellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (26.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (47.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e32 (49.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16 (24.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneral GI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (49.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e27 (24.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e32 (29.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIBD Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrohn\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (39.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.029\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81 (47.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.913\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.599\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e80 (47.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.078\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e48 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.212\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82 (48.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e64 (37.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e38 (22.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunosuppression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.149\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.019\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42 (27.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.033\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e82 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e44 (28.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.253\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (30.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99 (54.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (17.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62 (33.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e42 (23.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (32.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.462\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.285\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (23.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.616\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e83 (47.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.051\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e32 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (36.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61 (37.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e54 (32.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003ea\u003c/sup\u003e P-values represent univariate chi-squared analysis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of patients current on age-dependent vaccines\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eNeisseria\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eHPV\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCurrent (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCurrent (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall: 50 patients \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (44.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e13 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.166\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e9 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.007\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (31.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4 (12.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003e0.563\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003e0.801\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (47.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (30.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGI Provider\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIBD Specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.340\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e9 (24.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.504\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI Fellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e4 (36.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI Provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIBD Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrohn\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.631\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (18.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.030\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImmunosuppression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (47.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.238\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.418\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e3 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsurance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.907\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.418\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePublic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e6 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003ea\u003c/sup\u003e Patients between ages 18 and 27 were included in this cohort as these vaccines were age-dependent\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003eb\u003c/sup\u003e P-values represent univariate chi-squared analysis\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eVaccination Status\u003c/p\u003e \u003cp\u003eUnivariate chi-squared analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) showed that patients with Crohn disease were more likely to be vaccinated for influenza than those with UC \u003cem\u003e(\u003c/em\u003ep\u0026thinsp;=\u0026thinsp;.029). For the TDaP vaccination, patients who were female, Black, Hispanic and immunocompetent were more likely to be vaccinated than male, White and immunosuppressed patients (p\u0026thinsp;=\u0026thinsp;.002, .009 and .019 respectively). For the HAV vaccination, patients who were Black, Hispanic and immunosuppressed were more likely to be vaccinated rather than White and immunocompetent patients (p\u0026thinsp;=\u0026thinsp;.011 and .033 respectively). For the HBV vaccination, patients were more likely to be vaccinated if they were younger than 60, Black, Hispanic, followed by IBD Specialists or GI Fellows, and if they were immunosuppressed when compared to patients older than 60, White, followed by a general GI and if they were immunocompetent (p\u0026thinsp;=\u0026thinsp;.0001 for all). For the pneumococcus vaccinations, patients older than 60, Black, Hispanic, and those with public insurance were more likely to be vaccinated than patients younger than 60, White and with private insurance (p\u0026thinsp;=\u0026thinsp;.0001, .003, .002 respectively). For the HPV vaccination, patients who were male and those with UC were more likely to be vaccinated than females and those with Crohn disease (p\u0026thinsp;=\u0026thinsp;.007 and .030 respectively)\u003c/p\u003e \u003cp\u003eIn bivariate logistical regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), some of the initial trends seen in univariate analysis did not persist. With influenza, age was the only significant factor with patients under the age of 60 being less likely to be up to date on their influenza vaccine than patients age 60 and above (OR\u0026thinsp;=\u0026thinsp;0.55, p\u0026thinsp;=\u0026thinsp;0.025). With the TDaP vaccination, sex, race and immunosuppression status persisted in their significance. Females were more likely to be up to date than males (OR\u0026thinsp;=\u0026thinsp;1.65, p\u0026thinsp;=\u0026thinsp;0.005), while Black (OR\u0026thinsp;=\u0026thinsp;2.34, p\u0026thinsp;=\u0026thinsp;0.004) and Hispanic (OR\u0026thinsp;=\u0026thinsp;1.88, p\u0026thinsp;=\u0026thinsp;0.033) patients were more likely to be up to date with TDaP than White patients. Patients on immunosuppressive therapy were less likely to be up to date than patients not on immunosuppression (OR\u0026thinsp;=\u0026thinsp;0.53, p\u0026thinsp;=\u0026thinsp;0.017).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSignificant results of multivariate analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% Confidence Interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfluenza\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;60 vs Age \u0026ge;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33\u0026ndash;0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.025\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTDaP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale vs Male\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.05\u0026ndash;2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.031\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.30\u0026ndash;4.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.004\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.05\u0026ndash;3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.033\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunosuppression: Yes vs No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.32\u0026ndash;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.017\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHepatitis A\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.42\u0026ndash;6.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.005\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.20\u0026ndash;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.016\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHepatitis B\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026lt;\u0026thinsp;60 vs Age \u0026ge;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.74\u0026ndash;5.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.26\u0026ndash;8.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.0001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.40\u0026ndash;5.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian/Other vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.83\u0026ndash;35.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.006\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIBD Provider vs General GI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.38\u0026ndash;4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGI Fellows vs General GI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.32\u0026ndash;5.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.007\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePneumococcus (PCV13 and PPSV23)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.77\u0026ndash;8.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic vs White\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.03\u0026ndash;5.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.043\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUlcerative Colitis vs Crohn\u0026rsquo;s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.28\u0026ndash;0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.045\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunosuppression: Yes vs No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.05\u0026ndash;4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.035\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWith the HAV vaccination, race was the only significant factor that persisted. Black (OR\u0026thinsp;=\u0026thinsp;3.15, p\u0026thinsp;=\u0026thinsp;0.005) and Hispanic (OR\u0026thinsp;=\u0026thinsp;2.67, p\u0026thinsp;=\u0026thinsp;0.016) patients were more likely to be up to date with the HAV vaccination than White patients. For the HBV vaccination, age, race and type of GI provider persisted in their significance. Patients under the age of 60 were more likely to be up to date with the HBV vaccination than patients 60 and older (OR\u0026thinsp;=\u0026thinsp;3.04 p\u0026thinsp;=\u0026thinsp;0.0001). Black (OR\u0026thinsp;=\u0026thinsp;4.39, p\u0026thinsp;=\u0026thinsp;0.0001), Hispanic (OR\u0026thinsp;=\u0026thinsp;2.68, p\u0026thinsp;=\u0026thinsp;0.003), and Asian/Other (OR\u0026thinsp;=\u0026thinsp;8.03, p\u0026thinsp;=\u0026thinsp;0.006) patients were all more likely to be up to date with the HBV vaccination than White patients. Patients who followed with an IBD provider (OR\u0026thinsp;=\u0026thinsp;2.55, p\u0026thinsp;=\u0026thinsp;0.003) or GI Fellow (OR\u0026thinsp;=\u0026thinsp;2.73, p\u0026thinsp;=\u0026thinsp;0.007) were more likely to be up to date with the HBV vaccination than patients who followed up with a general GI provider.\u003c/p\u003e \u003cp\u003eFor the pneumococcus vaccinations, race was the only factor that persisted in significance but type of IBD and immunosuppression status were significant in multivariate analysis. Black (OR\u0026thinsp;=\u0026thinsp;3.85, p\u0026thinsp;=\u0026thinsp;0.001) and Hispanic (OR\u0026thinsp;=\u0026thinsp;2.29, p\u0026thinsp;=\u0026thinsp;0.043) patients were more likely to be up to date, as compared to White patients. Patients with UC were less likely than patients with Crohn disease to be up to date on their pneumococcus vaccinations (OR\u0026thinsp;=\u0026thinsp;0.52, p\u0026thinsp;=\u0026thinsp;0.045). Patients on immunosuppression were more likely to be up to date than patients not on immunosuppression (OR\u0026thinsp;=\u0026thinsp;2.06, p\u0026thinsp;=\u0026thinsp;0.035).\u003c/p\u003e \u003cp\u003eFor Meningococcal and HPV vaccinations, no factors were found to be significant.\u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003ePatients with IBD are at higher risk for certain serious infections which may be partly due to the use of immunosuppressive medication but also due to their underlying disease. Therefore, vaccinations in these patients are a critical part of their treatment plan, however rates of vaccinations in this patient population are lagging. This study is the first that examines the effect that type of GI provider plays on vaccination status in IBD patients. Focusing on seven inactivated vaccines recommended in the ACG clinical guidelines for preventive care in IBD patients, we performed an analysis of 338 IBD patients followed by GI providers at a single institution to see if type of GI provider affected vaccination status in IBD patients. The results showed that type of GI provider did not influence an IBD patient\u0026rsquo;s vaccination status for all but one of the seven inactivated vaccines. The HBV vaccination was the only vaccination where type of GI provider was significant for likelihood to be up to date with vaccination where IBD specialists and GI Fellows outperformed general GI providers. The significance of HBV specifically may be explained by the fact that IBD specialists may be more likely to prescribe immunosuppressive therapies such as a biologic or immunomodulator where immunization to HBV is considered standard of care prior to giving the medication. Also, insurers tend to request vaccination history including HBV status prior to approving the use of biologic, possibly contributing to the significant number of patients up to date with the HBV vaccination. GI Fellows also outperformed general GI providers as well, likely due to GI fellow supervision by IBD specialists when seeing IBD patients at this institution.\u003c/p\u003e \u003cp\u003eLooking beyond type of provider, there were several other interesting observations in regards to vaccinations in this IBD patient population. Race played a significant role in vaccination rates in multivariate analysis for four of the vaccines studied (TDaP, HAV, HBV, and Pneumococcus). For each of these vaccines, Black and Hispanic patients were better vaccinated than White patients. These results were surprising, given that other studies on racial differences in vaccine administration typically found that Black and Hispanic patients had lower rates of vaccine coverage [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. When comparing this cohort\u0026rsquo;s vaccination rates to the US national averages for these four vaccines, Black patients with IBD in this cohort were better vaccinated than Black Americans nationally (TDaP, HAV, HBV, and Pneumococcus rates of 57.9%, 27.1%, 52.3% and 37.4% in our cohort versus 51.1%, 10.2%, 27.0% and 34.2%) while White patients with IBD in this cohort were less likely to be vaccinated than White Americans nationally (TDaP, HAV, HBV, and Pneumococcus rates of 36.7%, 10.2%, 24.5% and 16.3% in our cohort versus 63.4%, 14.0%, 36.2% and 47.5%) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These differences could be attributed to the work of the institution itself since it is located in the Bronx, New York, one of the most racially diverse counties in the United States. The institution is sensitive to health inequities and disparities in their patients and as a result, has expertise in handling health issues in these minority patients. Also, since IBD patients utilize the health care system more than the general population, this may have allowed for higher vaccination rates at an institution that is focused on minority health issues as a whole [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAge was another factor that played a role in rates of vaccination for Influenza and the HBV vaccination. IBD patients 60 and older were better vaccinated against Influenza, while IBD patients under 60 were better vaccinated for HBV. This data is consistent with national trends in vaccination seen in both the general population and IBD patients specifically, showing that that younger patients were more likely to be current with HBV vaccination status and less likely to be current on influenza when compared to older patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. One reason for this trend could be due to enhanced influenza counselling by providers to older patients [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. For the HBV vaccination, as it is typically indicated for high risk patients such as those with IBD, one reason to explain why younger patients are better vaccinated is that the incidence of IBD is greater in younger people, leading to rates of vaccination that skew towards the younger population [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImmunosuppressive therapy also played a role in vaccination status for TDaP and Pneumococcus vaccines. Immunosuppressed IBD patients had a lower rate of being vaccinated for TDaP and a higher rate of being vaccinated for pneumococcus. A reason for why this effect was seen may be because TDaP is more likely to be given to patients by their PCP, rather than their GI provider [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. PCP\u0026rsquo;s are also less likely to immunize patients on immunosuppression, possibly explaining the negative effect immunosuppressive therapy had on TDaP [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Pneumococcus is primarily indicated for high risk patients (when under 65) such as those on immunosuppressive therapy. Given that this therapy is as an indication for the vaccine, it is likely that high-risk patients were better vaccinated due to the indication [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFinally, sex was seen to play a role in TDaP vaccination status, with women being more likely than men to be vaccinated. While there is no consistent data that supports this trend on a national level, a possible explanation for this is that ACIP guidelines since 2013 have recommended a TDaP shot for women during every pregnancy [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Pregnant women therefore may have led to better TDaP vaccination rates because of this additional opportunity to be vaccinated.\u003c/p\u003e \u003cp\u003eThis study had several limitations that are important to note. The first is related to the reliance on accuracy of data from one institution\u0026rsquo;s medical records. While efforts are made to update patient records to reflect care that was provided at outside institutions, it is possible that there were missed vaccinations if they were given elsewhere and not documented in the institution\u0026rsquo;s medical records. Another limitation is a lack of information as to what provider specifically ordered and administered vaccines. A GI provider may have requested a certain vaccination for their patient, however, if they were unable to administer it in their own practice it is out of their control whether or not a patient actually gets the requested vaccination. Finally, this study was unable to gather information on any reasons for why patients were not vaccinated. Previous studies have shown that patient anxiety plays a role in low vaccination rates among IBD patients, and it is possible that it played a role among this cohort as well [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite limitations, there were several strengths of this study including a large cohort of racially and socioeconomically diverse IBD patients following up at a single institution. Also, this study was the first to examine if differences in type of GI provider follow up affected vaccination rates. While type of GI provider may not influence the likelihood of vaccination, this study did show other factors that influenced vaccination rates specifically the effect of race. Black and Hispanic IBD patients were more likely to be vaccinated compared to White IBD patients for Tdap, the HAV vaccination, the HBV vaccination, and Pneumococcus vaccination, a finding which is not consistent with national vaccination rates amongst races. This may reflect more the work of the single institution that is located in a racially diverse county of New York and is focused on minority health issues. Future research should include efforts to better understand the effects of the institution itself on this finding or if there are other factors that shaped these results. Vaccination rates for the institution should be analyzed to compare with the IBD patients\u0026rsquo; vaccination rates to see if this finding is consistent with the institution as a whole or just to the IBD patients at the institution. Despite the interesting findings regarding race, this study shows IBD patients at this institution still lag in receiving appropriate vaccinations. Future studies should be done to better understand IBD patients and all GI providers attitudes and knowledge of vaccinations, as well as assessing for any barriers to vaccinations. With this information, areas to explain gaps in vaccination can be identified and prospective studies can be designed to address these issues specifically in hopes of improving vaccination rates for these patients.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eEthics Approval\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board at Albert Einstein College of Medicine and was deemed to be ethically conducted and carried out.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eThis study does not contain individual personal data, therefor consent for publication is not applicable.\u003c/p\u003e\n\u003cp\u003eAvailability of Data and Materials\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analyzed during the current study are not publicly available as they contain identifiable patient information and are stored on a secure hard drive. However, data can be de-identified and made available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo outside sources of funding were acquired for this study.\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contribution\u003c/p\u003e\n\u003cp\u003eMT collected, analyzed and interpreted patient data, as well as was a major contributor to writing the manuscript. Both NM and JK helped devise the study and played major roles in writing and refining the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNg SC, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. 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Racial and Ethnic Disparities in Vaccination Coverage Among Adult Populations in the U.S. Am J Prev Med. 2015;49(6 Suppl 4):S412-25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams WW, et al. Surveillance of Vaccination Coverage among Adult Populations - United States, 2015. MMWR Surveill Summ. 2017;66(11):1\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrevention Cf.D.C.a. \u003cem\u003eVaccination Coverage among Adults in the United States\u003c/em\u003e. 2018; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003c/span\u003e\u003c/span\u003e - ref04.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClick B, et al. Demographic and Clinical Predictors of High Healthcare Use in Patients with Inflammatory Bowel Disease. Inflamm Bowel Dis. 2016;22(6):1442\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBen Musa R, et al. Hepatitis B vaccination in patients with inflammatory bowel disease. World J Gastroenterol. 2014;20(41):15358\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAvelino-Silva VI, et al. Campaign, counseling and compliance with influenza vaccine among older persons. Clinics. 2011;66(12):2031\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenchimol EI, et al. Changing age demographics of inflammatory bowel disease in Ontario, Canada: a population-based cohort study of epidemiology trends. Inflamm Bowel Dis. 2014;20(10):1761\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosnes J, et al. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140(6):1785\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSelby L, Hoellein A, Wilson JF. Are primary care providers uncomfortable providing routine preventive care for inflammatory bowel disease patients? Dig Dis Sci. 2011;56(3):819\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVila-Corcoles A, et al. Pneumococcal vaccination coverages among low-, intermediate-, and high-risk adults in Catalonia. Hum Vaccin Immunother. 2016;12(11):2953\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFink AL, Klein SL. Sex and Gender Impact Immune Responses to Vaccines Among the Elderly. Physiology (Bethesda). 2015;30(6):408\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"IBD, Vaccinations, GI providers, IBD specialists, GI Fellows, General Gastroenterologists","lastPublishedDoi":"10.21203/rs.3.rs-148514/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-148514/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003c/p\u003e\u003cp\u003ePatients with Inflammatory Bowel Disease (IBD) are at heightened risk of infection, and are often under vaccinated. At our institution, IBD patients may follow up with one of three gastroenterology (GI) providers: IBD specialists, GI Fellows and General GI providers. \u003c/p\u003e\u003cp\u003eAims:\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\u003cp\u003eOur primary objective was to identify whether the type of GI provider had an effect on rates of vaccinations for IBD patients. The seven vaccines studied were listed in the American College of Gastroenterology’s 2017 Guidelines on Preventative Care in IBD, and include Influenza, Tetanus/Diphtheria/Pertussis, Hepatitis A (HAV), Hepatitis B (HBV), Pneumococcus (PCV13 and PPSV23), Meningococcus, and Human Papillomavirus (HPV).\u003c/p\u003e\u003cp\u003eMethods:\u003c/p\u003e\u003cp\u003eRetrospective case control study of IBD patients, looking at vaccination rates for each of the seven vaccinations listed above, and type of GI provider followed. Other data collected included patient demographics, IBD type, treatment regimen and insurance.\u003c/p\u003e\u003cp\u003eResults:\u003c/p\u003e\u003cp\u003eOf 338 IBD patients, 65 (19.2%) followed up with a GI fellow, 110 (32.5%) with a general GI provider, and 163 (48.2%) with an IBD specialist. HBV was the only vaccine with a significant difference in vaccination rate by type of provider. Bivariate analysis showed that patients who followed with IBD specialists and GI fellows were more likely to be vaccinated for HBV than patients who followed up with general GI provider (OR = 2.55, p = .003 and OR = 2.73, p = .007 respectively).\u003c/p\u003e\u003cp\u003eConclusion \u003c/p\u003e\u003cp\u003eType of GI provider only impacted rates of vaccination for HBV among IBD patients in this study, with IBD specialists and GI fellows outperforming general GI providers.\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Type of GI Provider Does Not Affect Rates of Vaccination Amongst Inflammatory Bowel Disease Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-01-19 18:17:22","doi":"10.21203/rs.3.rs-148514/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2021-05-09T00:00:00+00:00","index":1,"fulltext":""},{"type":"editorAssigned","content":"","date":"2021-01-13T00:00:00+00:00","index":"","fulltext":""},{"type":"reviewersInvited","content":"","date":"2021-01-13T00:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2021-01-12T23:00:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2021-01-12T23:00:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"","date":"2020-12-25T00:00:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e9ee3e53-6f6c-4dd0-859c-68ea12fa46d8","owner":[],"postedDate":"January 19th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":1930426,"name":"Gastroenterology \u0026 Hepatology"}],"tags":[],"updatedAt":"2021-01-19T18:17:22+00:00","versionOfRecord":[],"versionCreatedAt":"2021-01-19 18:17:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-148514","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-148514","identity":"rs-148514","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}