Association between a usual source of care and influenza vaccination rates among pregnant women

Age of Autism Spectrum Disorder Diagnosis and Patient-Centered Medical Home Components

Early diagnosis of autism spectrum disorder (ASD) in children facilitates the provision of services and enhances opportunities for improving functioning via intervention. To date, limited studies have examined whether age of ASD diagnosis is associated with components of care of the patient-centered medical home (PCMH), a model of health care that emphasizes centralized, accessible, and coordinated care. The objective of the current study was to evaluate the associations between components of the PCMH and age of ASD diagnosis while controlling for associated clinical and socio-demographic factors, in a national sample of children 17 years and younger with ASD. The present study was a cross-sectional, observational study. Participants were caregivers of 1,193 children ages with ASD from the 2020 National Survey of Children's Health (NSCH). Hierarchical multiple linear regression analysis was run with age of ASD diagnosis as the criterion variable in two regression models. The binary composite medical home proxy variable was investigated as well as the five individual medical home components (usual source of care, personal doctor or nurse, family-centered care, care coordination, able to obtain referrals when needed). In the first regression analysis, the overall PCMH proxy variable was significantly correlated with the age of ASD diagnosis (standardized beta coefficient = -.08; p < .01). Of the five components of the PCMH assessed in the second regression model, only usual source of sick care was significantly associated with the age of ASD diagnosis (standardized beta coefficient = -.11; p < .01). Having a usual source of sick care may be an important factor in receiving an earlier ASD diagnosis for children and adolescents.

Influenza vaccine during pregnancy, recommendations from healthcare providers, and race/ethnicity in the United States

OBJECTIVES

We examined racial/ethnic differences in the association between influenza vaccine recommendations from healthcare providers and maternal vaccination uptake.

METHODS

This cross-sectional study examined data from the Pregnancy Risk Assessment Monitoring System. We categorized respondents as non-Hispanic (NH) Whites, NH-Blacks, NH-Asians, American Indians/Alaska Natives, NH Other non-Whites, and Hispanics. We conducted multivariable logistical regression models to evaluate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Covariates included maternal age, marital status, education, insurance status before pregnancy, the number of previous live births, the number of prenatal care visits, and smoking status during pregnancy.

RESULTS

The prevalences of receiving influenza vaccine recommendations from healthcare providers and maternal vaccine were 80.01% and 50.42%, respectively. NH-Blacks are less likely to receive provider recommendations (AOR = 0.82; 95%CI 0.77-0.87) and be vaccinated (AOR = 0.76; 95%CI 0.72-0.80) than NH-Whites. Receiving provider recommendations was significantly associated with increased maternal influenza vaccine uptake (AOR = 15.50; 95% CI 14.51-16.55). The associations were significant for all racial/ethnic groups, with the highest among NH-Asians (AOR = 22.04; 95% CI 17.88-27.16) and the lowest among NH Other non-Whites (AOR = 11.07; 95% CI 8.25-14.86). Within NH-Asians, effectiveness among Chinese was highest (AOR = 29.39; 95% CI 18.10-47.71).

CONCLUSIONS

Racial/ethnic disparities in maternal influenza vaccine uptake and receiving vaccine recommendations from healthcare providers persisted. Further studies on the racial/ethnic disparities in maternal vaccination were warranted and tailored strategies are required to reduce this health disparity.