A population-based cohort study of undervaccination in 8 managed care organizations across the United States

Jason M. Glanz, Sophia R. Newcomer, Komal J. Narwaney, Simon J. Hambidge, Matthew F. Daley, Nicole M. Wagner, David L. McClure, Stan Xu, Ali Rowhani-Rahbar, Grace M. Lee, Jennifer C. Nelson, James G. Donahue, Allison L. Naleway, James D. Nordin, Marlene M. Lugg, Eric S. Weintraub

Research output: Contribution to journalArticlepeer-review

143 Scopus citations


Objectives: To examine patterns and trends of undervaccination in children aged 2 to 24 months and to compare health care utilization rates between undervaccinated and age-appropriately vaccinated children. Design: Retrospective matched cohort study. Setting: Eight managed care organizations of the Vaccine Safety Datalink. Participants: Children born between 2004 and 2008. Main Exposure: Immunization records were used to calculate the average number of days undervaccinated. Two matched cohorts were created: 1 with children who were undervaccinated for any reason and 1 with children who were undervaccinated because of parental choice. For both cohorts, undervaccinated children were matched to age-appropriately vaccinated children by birth date, managed care organization, and sex. Main Outcome Measures: Rates of undervaccination, specific patterns of undervaccination, and health care utilization rates. Results: Of 323 247 children born between 2004 and 2008, 48.7% were undervaccinated for at least 1 day before age 24 months. The prevalence of undervaccination and specific patterns of undervaccination increased over time (P<.001). In a matched cohort analysis, undervaccinated children had lower outpatient visit rates compared with childrenwhowere age-appropriately vaccinated (incidence rate ratio [IRR],0.89; 95% CI, 0.89-0.90). In contrast, undervaccinated children had increased inpatient admission rates compared with age-appropriately vaccinated children (IRR,1.21; 95% CI, 1.18-1.23). In a second matched cohort analysis, children who were undervaccinated because of parental choice had lower rates of outpatient visits (IRR, 0.94; 95% CI, 0.93-0.95) and emergency department encounters (IRR,0.91; 95% CI, 0.88-0.94) than age-appropriately vaccinated children. Conclusions: Undervaccination appears to be an increasing trend. Undervaccinated children appear to have different health care utilization patterns compared with age-appropriately vaccinated children.

Original languageEnglish
Pages (from-to)274-281
Number of pages8
JournalJAMA Pediatrics
Issue number3
StatePublished - Mar 2013


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