Influenza Vaccination Among Children With Asthma in Medicaid Managed Care

To describe influenza vaccination rates and identify risk factors for missing vaccination among children with asthma in managed Medicaid. As part of a longitudinal study of asthma care quality, parents of children aged 2–16 years with asthma enrolled in Medicaid managed care organizations in Massachusetts, Washington, and California were surveyed by telephone at baseline and 1 year. We evaluated influenza vaccination rates during the follow-up year. The study population included 1058 children with asthma. The influenza vaccination rate was 16% among all children with asthma and 21% among those with persistent asthma. Children with persistent asthma (odds ratio [OR] 0.53, 95% confidence interval [CI] 0.36–0.79) and those who had been hospitalized during the follow-up year (OR 0.29, 95% CI 0.11–0.76) were less likely to miss vaccination.Children older than 9 years (OR 1.66, 95% CI 1.13–2.46) and children of parents with less than a high school education (OR 2.29, 95% CI 1.05–5.03), compared with a college degree, were at risk for missing vaccination. Among children with persistent asthma, older children (OR 1.65, 95% CI 1.01–2.69) and children of parents with less than a high school education (OR 4.13, 95% CI 1.43–11.90) were more likely to miss influenza vaccination. Our findings suggest that interventions directed toward older children and families with lower educational levels may help improve influenza vaccination rates among this high-risk group. The low overall vaccination rate highlights the need for improvement in this important component of asthma care quality for all children with asthma.