Assessing Influenza Vaccination Coverage Among An Urban Pediatric Asthma Population:  A Geospatial Analysis

Abstract Background: Asthma is the most common chronic disease in children. Children with asthma are at high risk for complications from influenza; yet, annual influenza vaccination rates are suboptimal. The overall aim of this study was to describe the characteristics of a high-risk group of children with asthma according to influenza vaccination status. Methods: The study was a retrospective chart review of 4355 patients aged 2 to 18 years evaluated in the pediatric emergency department (PED) between November 1, 2017 and April 30, 2018 with an ICD-10-CM code for asthma (J45.x). Eligible patient PED records were matched with influenza vaccination records for the 2017-2018 influenza season from the Michigan Care Improvement Registry. Geospatial analysis was employed to examine the distribution of influenza vaccination status. Results: 1049 patients (30.9%) with asthma seen in the PED had received an influenza vaccine. Influenza vaccination coverage varied by Census Tract, ranging from 10% to >99%. Most vaccines were administered in a primary care setting (84.3%) and were covered by public insurance (76.8%). The influenza vaccination rate was lowest for children aged 5-11 (30.0%) years and vaccination status was associated with race (p<0.001) and insurance type (p<0.001). Conclusions: Identification of neighborhood Census Tract and demographic groups with suboptimal influenza vaccination could guide development of targeted public health interventions to improve vaccination rates in high-risk patients. Given the morbidity and mortality associated with pediatric asthma, a data-driven approach may improve patient outcomes and reduce healthcare-associated costs.