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Newcomer SR, Graham J, Irish K, Freeman RE, Leary CS, Wehner BK, Daley MF. Identification of Spatial Clusters of Undervaccination Patterns Among Children Aged <24 Months Using Immunization Information System Data, Montana, 2015-2019. Public Health Rep 2024; 139:360-368. [PMID: 37503702 PMCID: PMC11037227 DOI: 10.1177/00333549231186603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Spatial clustering of undervaccination leads to increased risk of vaccine-preventable diseases. We identified spatial clustering of undervaccination patterns among children aged <24 months in Montana. METHODS We used Montana's immunization information system data to analyze deidentified vaccination records of children aged <24 months born from January 2015 through November 2017. We measured 3 outcomes that were not mutually exclusive: not completing the combined 7-vaccine series by age 24 months, having an undervaccination pattern indicative of parental hesitancy, and having an undervaccination pattern indicative of structural barriers to timely vaccination. Using geomasked residential addresses, we conducted separate Bernoulli spatial scans with a randomization P < .01 to identify spatial clusters consisting of ≥100 children for each outcome and calculated the relative risk of having the undervaccination pattern inside versus outside the cluster. RESULTS Of 31 201 children aged <24 months included in our study, 11 712 (37.5%) had not completed the combined 7-vaccine series by age 24 months, and we identified 5 spatial clusters of this outcome across Montana. We identified 4 clusters of undervaccination patterns indicative of parental vaccine hesitancy, all in western Montana. The cluster with the largest relative risk (2.3) had a radius of 23.7 kilometers (n = 762 children, P < .001). We also identified 4 clusters of undervaccination patterns indicative of structural barriers, with 3 of the largest clusters in eastern Montana. CONCLUSION In Montana, different strategies to increase routine and timely childhood vaccination are needed in distinct areas of this large and predominantly rural state. Immunization information system data can pinpoint areas where interventions to increase vaccination uptake are needed.
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Affiliation(s)
- Sophia R. Newcomer
- School of Public and Community Health Sciences and Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Jon Graham
- Department of Mathematical Sciences and Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Kayla Irish
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Rain E. Freeman
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Cindy S. Leary
- Center for Population Health Research, University of Montana, Missoula, MT, USA
| | - Bekki K. Wehner
- Communicable Disease Bureau, Montana Department of Public Health and Human Services, Helena, MT, USA
| | - Matthew F. Daley
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
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Michels SY, Niccolai LM, Hadler JL, Freeman RE, Albers AN, Glanz JM, Daley MF, Newcomer SR. Failure to Complete Multidose Vaccine Series in Early Childhood. Pediatrics 2023; 152:e2022059844. [PMID: 37489285 PMCID: PMC10389773 DOI: 10.1542/peds.2022-059844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Most early childhood immunizations require 3 to 4 doses to achieve optimal protection. Our objective was to identify factors associated with starting but not completing multidose vaccine series. METHODS Using 2019 National Immunization Survey-Child data, US children ages 19 to 35 months were classified in 1 of 3 vaccination patterns: (1) completed the combined 7-vaccine series, (2) did not initiate ≥1 of the 7 vaccine series, or (3) initiated all series, but did not complete ≥1 multidose series. Associations between sociodemographic factors and vaccination pattern were evaluated using multivariable log-linked binomial regression. Analyses accounted for the survey's stratified design and complex weighting. RESULTS Among 16 365 children, 72.9% completed the combined 7-vaccine series, 9.9% did not initiate ≥1 series, and 17.2% initiated, but did not complete ≥1 multidose series. Approximately 8.4% of children needed only 1 additional vaccine dose from 1 of the 5 multidose series to complete the combined 7-vaccine series. The strongest associations with starting but not completing multidose vaccine series were moving across state lines (adjusted prevalence ratio [aPR] = 1.45, 95% confidence interval [CI]: 1.18-1.79), number of children in the household (2 to 3: aPR = 1.29, 95% CI: 1.05-1.58; 4 or more: aPR = 1.68, 95% CI: 1.30-2.18), and lack of insurance coverage (aPR = 2.03, 95% CI: 1.42-2.91). CONCLUSIONS More than 1 in 6 US children initiated but did not complete all doses in multidose vaccine series, suggesting children experienced structural barriers to vaccination. Increased focus on strategies to encourage multidose series completion is needed to optimize protection from preventable diseases and achieve vaccination coverage goals.
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Affiliation(s)
- Sarah Y. Michels
- Yale School of Public Health, New Haven, Connecticut
- Center for Population Health Research, University of Montana, Missoula, Montana
| | | | | | - Rain E. Freeman
- Center for Population Health Research, University of Montana, Missoula, Montana
| | - Alexandria N. Albers
- Center for Population Health Research, University of Montana, Missoula, Montana
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Sophia R. Newcomer
- Center for Population Health Research, University of Montana, Missoula, Montana
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana
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Newcomer SR, Glanz JM, Daley MF. Beyond Vaccination Coverage: Population-Based Measurement of Early Childhood Immunization Schedule Adherence. Acad Pediatr 2023; 23:24-34. [PMID: 35995410 PMCID: PMC10253042 DOI: 10.1016/j.acap.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 01/19/2023]
Abstract
The immunization schedule recommended by the U.S. Advisory Committee on Immunization Practices (ACIP) provides a structure for how 10 different vaccine series should be administered to children in the first 18 months of life. Progress toward US early childhood immunization goals has largely focused on measuring vaccination coverage at age 24 months. However, standard vaccination coverage measures do not reflect whether children received vaccine doses by recommended ages, or whether vaccines were given concomitantly, per the schedule. In this paper, we describe innovations in population-level measurement of immunization schedule adherence through quantifying vaccination timeliness and undervaccination patterns. Measuring vaccination timeliness involves comparing when children received vaccine doses relative to ACIP age recommendations. To assess undervaccination patterns, children's vaccination histories are analyzed to determine whether they were vaccinated consistent with the ACIP schedule. Some patterns, such as spreading out vaccines across visits, are indicative of parental hesitancy. Other patterns, such as starting all recommended series but missing doses, are largely indicative of other immunization services delivery challenges. Since 2003, at least 12 studies have used National Immunization Survey-Child, immunization information system, or integrated health plan data to measure vaccination timeliness or undervaccination patterns at national or state levels. Moving forward, these novel measures can be leveraged for population-based surveillance of vaccine confidence, and for distinguishing undervaccination due to parental vaccine hesitancy from undervaccination due to other causes. Broader adoption of these measures can facilitate identification of targeted strategies for improving timely and routine early childhood vaccination uptake across the United States.
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Affiliation(s)
- Sophia R Newcomer
- University of Montana School of Public and Community Health Sciences (SR Newcomer), Missoula, Mont; University of Montana Center for Population Health Research (SR Newcomer), Missoula, Mont.
| | - Jason M Glanz
- Kaiser Permanente Colorado, Institute for Health Research (JM Glanz, MF Daley), Aurora, Colo; University of Colorado, Colorado School of Public Health, Department of Epidemiology (JM Glanz), Aurora, Colo
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research (JM Glanz, MF Daley), Aurora, Colo; University of Colorado, School of Medicine, Department of Pediatrics (MF Daley), Aurora, Colo
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Daley MF, Reifler LM, Glanz JM, Hambidge SJ, Getahun D, Irving SA, Nordin JD, McClure DL, Klein NP, Jackson ML, Kamidani S, Duffy J, DeStefano F. Association Between Aluminum Exposure From Vaccines Before Age 24 Months and Persistent Asthma at Age 24 to 59 Months. Acad Pediatr 2023; 23:37-46. [PMID: 36180331 PMCID: PMC10109516 DOI: 10.1016/j.acap.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/20/2022] [Accepted: 08/13/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the association between cumulative aluminum exposure from vaccines before age 24 months and persistent asthma at age 24 to 59 months. METHODS A retrospective cohort study was conducted in the Vaccine Safety Datalink (VSD). Vaccination histories were used to calculate cumulative vaccine-associated aluminum in milligrams (mg). The persistent asthma definition required one inpatient or 2 outpatient asthma encounters, and ≥2 long-term asthma control medication dispenses. Cox proportional hazard models were used to evaluate the association between aluminum exposure and asthma incidence, stratified by eczema presence/absence. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) per 1 mg increase in aluminum exposure were calculated, adjusted for birth month/year, sex, race/ethnicity, VSD site, prematurity, medical complexity, food allergy, severe bronchiolitis, and health care utilization. RESULTS The cohort comprised 326,991 children, among whom 14,337 (4.4%) had eczema. For children with and without eczema, the mean (standard deviation [SD]) vaccine-associated aluminum exposure was 4.07 mg (SD 0.60) and 3.98 mg (SD 0.72), respectively. Among children with and without eczema, 6.0% and 2.1%, respectively, developed persistent asthma. Among children with eczema, vaccine-associated aluminum was positively associated with persistent asthma (aHR 1.26 per 1 mg increase in aluminum, 95% CI 1.07, 1.49); a positive association was also detected among children without eczema (aHR 1.19, 95% CI 1.14, 1.25). CONCLUSION In a large observational study, a positive association was found between vaccine-related aluminum exposure and persistent asthma. While recognizing the small effect sizes identified and the potential for residual confounding, additional investigation of this hypothesis appears warranted.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley, LM Reifler, and JM Glanz), Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine (MF Daley and SJ Hambidge), Aurora, Colo.
| | - Liza M Reifler
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley, LM Reifler, and JM Glanz), Aurora, Colo
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado (MF Daley, LM Reifler, and JM Glanz), Aurora, Colo; Colorado School of Public Health (JM Glanz), Aurora, Colo
| | - Simon J Hambidge
- Department of Pediatrics, University of Colorado School of Medicine (MF Daley and SJ Hambidge), Aurora, Colo; Community Health Services, Denver Health (SJ Hambidge), Denver, Colo
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California (D Getahun), Pasadena, Calif; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine (D Getahun), Pasadena, Calif
| | - Stephanie A Irving
- Center for Health Research, Kaiser Permanente Northwest (SA Irving), Portland, Ore
| | | | - David L McClure
- Marshfield Clinic Research Institute (DL McClure), Marshfield, Wis
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California (NP Klein), Oakland, Calif
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute (ML Jackson), Seattle, Wash
| | - Satoshi Kamidani
- Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Department of Pediatrics, Emory University School of Medicine (S Kamidani), Atlanta, Ga; Immunization Safety Office, Centers for Disease Control and Prevention (S Kamidani, J Duffy, and F DeStefano), Atlanta, Ga
| | - Jonathan Duffy
- Immunization Safety Office, Centers for Disease Control and Prevention (S Kamidani, J Duffy, and F DeStefano), Atlanta, Ga
| | - Frank DeStefano
- Immunization Safety Office, Centers for Disease Control and Prevention (S Kamidani, J Duffy, and F DeStefano), Atlanta, Ga
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Freeman RE, Thaker J, Daley MF, Glanz JM, Newcomer SR. Vaccine timeliness and prevalence of undervaccination patterns in children ages 0-19 months, U.S., National Immunization Survey-Child 2017. Vaccine 2022; 40:765-773. [PMID: 34961632 PMCID: PMC8856130 DOI: 10.1016/j.vaccine.2021.12.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Typically, early childhood vaccination coverage in the U.S. is measured as the proportion of children by age 24 months who completed recommended vaccine series. However, these measures do not reflect whether vaccine doses were received at the ages recommended by the U.S. Advisory Committee on Immunization Practices, or whether children received vaccines concomitantly, per the ACIP recommended schedule. This study's objective was to quantify vaccine timeliness and prevalence of specific patterns of undervaccination in U.S. children ages 0-19 months. METHODS Using 2017 National Immunization Survey-Child data, we calculated days undervaccinated for the combined 7-vaccine series and distinguished undervaccination patterns indicative of parental vaccine hesitancy, such as spreading out vaccines across visits ("shot-limiting") or starting some but not all recommended vaccine series ("selective vaccination"), from other non-hesitancy patterns, such as missing final vaccine doses or receiving all doses, with some or all late. We measured associations between demographic, socioeconomic and other characteristics with undervaccination patterns using multivariable log-linked binomial regression. Analyses accounted for the complex survey design. RESULTS Among n = 15,333 U.S. children, only 41.2% received all recommended vaccine doses on-time by age 19 months. Approximately 20.9% of children had an undervaccination pattern suggestive of parental vaccine hesitancy, and 36.2% had other undervaccination non-hesitancy patterns. Uninsured children and those with lower levels of maternal education were more likely to exhibit undervaccination patterns suggestive of parental hesitancy. Lower levels of maternal education were also associated with other non-hesitancy undervaccination patterns. CONCLUSIONS More than half of children in the U.S. are undervaccinated at some point by 19 months of age. Ongoing assessment of vaccine timeliness and immunization schedule adherence could facilitate timely and targeted public health interventions in populations with high levels of undervaccination.
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Affiliation(s)
- Rain E. Freeman
- School of Public and Community Health Sciences, University of Montana, Missoula, MT
| | - Juthika Thaker
- School of Public and Community Health Sciences, University of Montana, Missoula, MT
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO;,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO;,Department of Epidemiology, University of Colorado School of Public Health, Aurora, CO
| | - Sophia R. Newcomer
- School of Public and Community Health Sciences, University of Montana, Missoula, MT
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Jenssen BP, Fiks AG. COVID-19 and Routine Childhood Vaccinations-Identifying Gaps and Informing Solutions. JAMA Pediatr 2022; 176:21-23. [PMID: 34617971 DOI: 10.1001/jamapediatrics.2021.4248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pediatric Clinical Effectiveness, The Possibilities Project, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Center for Pediatric Clinical Effectiveness, The Possibilities Project, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Daley MF, Reifler LM, Shoup JA, Narwaney KJ, Kharbanda EO, Groom HC, Jackson ML, Jacobsen SJ, McLean HQ, Klein NP, Williams JTB, Weintraub ES, McNeil MM, Glanz JM. Temporal Trends in Undervaccination: A Population-Based Cohort Study. Am J Prev Med 2021; 61:64-72. [PMID: 34148627 PMCID: PMC8899861 DOI: 10.1016/j.amepre.2021.01.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Monitoring the trends in undervaccination, including that because of parental vaccine refusal or delay, can inform public health responses directed at improving vaccine confidence and vaccination coverage. METHODS A retrospective cohort study was conducted in the Vaccine Safety Datalink. The cohort included all children born in 2004-2017 with ≥3 well-child visits between ages 2 and 23 months. Using electronic health record-based vaccination data, the average days undervaccinated was calculated for each child. Undervaccination patterns were assessed through age 23 months. Temporal trends were inspected for inflection points and were analyzed using linear regression. Nested within the cohort study, a survey was conducted to compare parent reports of vaccine refusal or delay with observed vaccination patterns. Data were analyzed in 2020. RESULTS The study cohort consisted of 808,170 children. The percentage of children with average days undervaccinated=0 (fully vaccinated, no delays) rose from a nadir of 47.1% for the birth year 2008 to 68.4% for the birth year 2017 (ptrend<0.001). The percentage with no vaccines rose from 0.35% for the birth year 2004 to 1.28% for the birth year 2017 (ptrend<0.001). Consistent vaccine limiting was observed in 2.04% for the birth year 2017. Omission of measles, mumps, and rubella vaccine peaked at 4.76% in the birth year 2007 and declined thereafter (ptrend<0.001). On the parent survey (response rate 60.2%), a high proportion of parents of the most undervaccinated children reported refusing or delaying vaccines. CONCLUSIONS In a 14-year cohort study, vaccination timeliness has improved. However, the small but increasing number of children who received no vaccines by age 23 months warrants additional attention.
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Affiliation(s)
- Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus Aurora, Colorado.
| | - Liza M Reifler
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Komal J Narwaney
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | | | - Holly C Groom
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | - Huong Q McLean
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, California
| | - Joshua T B Williams
- Department of General Pediatrics, Denver Health and Hospitals, Denver, Colorado
| | - Eric S Weintraub
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
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Xu S, Clarke CL, Newcomer SR, Daley MF, Glanz JM. Sensitivity analyses of unmeasured and partially-measured confounders using multiple imputation in a vaccine safety study. Pharmacoepidemiol Drug Saf 2021; 30:1200-1213. [PMID: 33988275 DOI: 10.1002/pds.5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/06/2021] [Indexed: 11/12/2022]
Abstract
PURPOSE Sensitivity analyses have played an important role in pharmacoepidemiology studies using electronic health records data. Despite the existence of quantitative bias analysis in pharmacoepidemiologic studies, simultaneously adjusting for unmeasured and partially measured confounders is challenging in vaccine safety studies. Our objective was to develop a flexible approach for conducting sensitivity analyses of unmeasured and partially-measured confounders concurrently for a vaccine safety study. METHODS We derived conditional probabilities for an unmeasured confounder based on bias parameters, used these conditional probabilities and Monte Carlo simulations to impute the unmeasured confounder, and re-constructed the analytic datasets as if the unmeasured confounder had been observed. We simultaneously imputed a partially measured confounder using a prediction model. We considered unmeasured breastfeeding and partially measured family history of Type 1 diabetes (T1DM) in a study examining the association between exposure to rotavirus vaccination and T1DM. RESULTS Before sensitivity analyses, the hazard ratios (HR) were 1.50 (95% CI, 0.81-2.77) for those partially exposed and 1.03 (95% CI, 0.62-1.72) for those fully exposed with unexposed children as the referent group. When breastfeeding and family history of T1DM were adjusted, the HR was 1.55 (95% CI, 0.84-2.87) for the partially exposed group; the HR was 0.98 (95% CI, 0.58-1.63) for the fully exposed group. CONCLUSIONS We conclude that adjusting for unmeasured breastfeeding and partially measured family history of T1DM did not alter the conclusion that there was no evidence of association between rotavirus vaccination and developing T1DM. This novel approach allows for simultaneous adjustment for multiple unmeasured and partially-measured confounders.
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Affiliation(s)
- Stanley Xu
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
| | - Christina L Clarke
- The Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Sophia R Newcomer
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Matthew F Daley
- The Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jason M Glanz
- The Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,School of Public Health, University of Colorado, Aurora, Colorado, USA
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Glanz JM, Clarke CL, Xu S, Daley MF, Shoup JA, Schroeder EB, Lewin BJ, McClure DL, Kharbanda E, Klein NP, DeStefano F. Association Between Rotavirus Vaccination and Type 1 Diabetes in Children. JAMA Pediatr 2020; 174:455-462. [PMID: 32150236 PMCID: PMC7063538 DOI: 10.1001/jamapediatrics.2019.6324] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Because rotavirus infection is a hypothesized risk factor for type 1 diabetes, live attenuated rotavirus vaccination could increase or decrease the risk of type 1 diabetes in children. OBJECTIVE To examine whether there is an association between rotavirus vaccination and incidence of type 1 diabetes in children aged 8 months to 11 years. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of 386 937 children born between January 1, 2006, and December 31, 2014, was conducted in 7 US health care organizations of the Vaccine Safety Datalink. Eligible children were followed up until a diagnosis of type 1 diabetes, disenrollment, or December 31, 2017. EXPOSURES Rotavirus vaccination for children aged 2 to 8 months. Three exposure groups were created. The first group included children who received all recommended doses of rotavirus vaccine by 8 months of age (fully exposed to rotavirus vaccination). The second group had received some, but not all, recommended rotavirus vaccines (partially exposed to rotavirus vaccination). The third group did not receive any doses of rotavirus vaccines (unexposed to rotavirus vaccination). MAIN OUTCOMES AND MEASURES Incidence of type 1 diabetes among children aged 8 months to 11 years. Type 1 diabetes was identified by International Classification of Diseases codes: 250.x1, 250.x3, or E10.xx in the outpatient setting. Cox proportional hazards regression models were used to analyze time to type 1 diabetes incidence from 8 months to 11 years. Hazard ratios and 95% CIs were calculated. Models were adjusted for sex, race/ethnicity, birth year, mother's age, birth weight, gestational age, number of well-child visits, and Vaccine Safety Datalink site. RESULTS In a cohort of 386 937 children (51.1% boys and 41.9% non-Hispanic white), 360 169 (93.1%) were fully exposed to rotavirus vaccination, 15 765 (4.1%) were partially exposed to rotavirus vaccination, and 11 003 (2.8%) were unexposed to rotavirus vaccination. Children were followed up a median of 5.4 years (interquartile range, 3.8-7.8 years). The total person-time follow-up in the cohort was 2 253 879 years. There were 464 cases of type 1 diabetes in the cohort, with an incidence rate of 20.6 cases per 100 000 person-years. Compared with children unexposed to rotavirus vaccination, the adjusted hazard ratio was 1.03 (95% CI, 0.62-1.72) for children fully exposed to rotavirus vaccination and 1.50 (95% CI, 0.81-2.77) for children partially exposed to rotavirus vaccination. CONCLUSIONS AND RELEVANCE The findings of this study suggest that rotavirus vaccination does not appear to be associated with type 1 diabetes in children.
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Affiliation(s)
- Jason M. Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora,Department of Epidemiology, Colorado School of Public Health, Aurora
| | | | - Stanley Xu
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Matthew F. Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
| | - Emily B. Schroeder
- Institute for Health Research, Kaiser Permanente Colorado, Aurora,Department of Endocrinology, Parkview Health and Parkview Physicians Group, Fort Wayne, Indiana
| | - Bruno J. Lewin
- Kaiser Permanente Department of Research and Evaluation, Kaiser Permanente of Southern California, Pasadena
| | - David L. McClure
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Elyse Kharbanda
- Division of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - Nicola P. Klein
- Kaiser Permanente Division of Research, Kaiser Permanente of Northern California, Oakland
| | - Frank DeStefano
- Immunization Safety Office, Vaccine Safety Datalink, Centers for Disease Control and Prevention, Atlanta, Georgia
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