OBJECTIVES: Despite recommended routine vaccination with meningococcal conjugate vaccine (MenACWY) at age 11-12 and booster at age 16, US national survey data suggest that MenACWY uptake is lower in older adolescents than younger adolescents. This study aimed to evaluate healthcare utilization factors influencing MenACWY uptake and potential missed opportunities for vaccination.
METHODS: Data from the 2011-2016 MarketScan US claims databases were retrospectively analyzed, focusing on commercial- and Medicaid-enrolled adolescents with continuous enrollment during two age ranges: 10.5-13 (younger) and 15.5-18 (older). Multivariable logistic regression and nonlinear decomposition analyses were used to identify factors associated with MenACWY vaccination, presence of potential missed opportunities for vaccination, and observed differences between older and younger adolescents within each payer type.
RESULTS: In multivariable models for the commercially-insured population, older adolescents were less likely than younger adolescents to receive a MenACWY dose (adjusted odds ratio [OR] [95% confidence interval (95%CI)]: 0.68 [0.67, 0.69]) and more likely to have a missed opportunity (OR [95%CI]: 1.27 [1.25, 1.28]). Adolescents with a rural residence or non-pediatrician provider were less likely to receive a MenACWY dose and more likely to have a missed opportunity. Decomposition results indicated that lower MenACWY coverage in older adolescents versus younger adolescents (71.7% and 48.9%, respectively) was largely attributable to fewer non-MenACWY vaccines received, fewer preventive care visits, and primary interaction with healthcare providers other than pediatricians. Similarly, the inter-age group difference in missed opportunities (31.9% among older adolescents, 21.6% among younger adolescents) was driven by fewer non-MenACWY vaccines received and primary healthcare provider type. Similar results were seen within the Medicaid population.
CONCLUSIONS: MenACWY vaccine coverage was significantly higher in the younger adolescents compared to the older adolescents, largely attributable to differences in healthcare utilization. Presence of missed opportunities in both age groups suggest further room for improvement. Different strategies may be required in each age group.
