(202) Identification of factors that may contribute to vaccine hesitancy in a high risk members of a Commercial Health Plan

Background: : Despite the proven benefits of adult immunization, vaccination rates among at-risk adults, particularly those aged 50 and older with chronic conditions, remain below national targets. Patients continue to experience lower uptake of recommended vaccines due to barriers including cost concerns, lack of access, mistrust of the health care system, misinformation, and limited provider engagement. This study investigates structural and behavioral barriers to vaccination in this population using national survey and claims data.

Objective: : The primary objective was to identify barriers to vaccination among commercially insured, at-risk adults. Secondary objectives included evaluating the influence of sociodemographic factors on uptake, comparing pharmacy versus primary care access, and assessing patterns in newer vaccines (RSV, shingles) relative to established ones (influenza, pneumococcal).

Methods: : This retrospective observational study utilized the BlueKC claims database, NHIS, BRFSS, CDC AdultVaxView, and the Area Deprivation Index. The study population included adults ≥50 years with at least one chronic condition. Descriptive statistics, Chi-square, Two-proportion tests, and t-tests assessed associations between demographics, neighborhood disadvantage, and vaccine utilization.

Results: : Analyses show vaccination coverage for influenza, COVID-19, shingles, pneumococcal disease, and RSV remains suboptimal in adults with chronic conditions. Of 4,578 patients, 1,392 were unvaccinated, including 919 of 2,800 females and 473 of 1,778 males, a 6.2% difference (p < 0.001). Rates were lowest in disadvantaged and minority groups, with about 30–35% unvaccinated across risk categories. Barriers included cost, misinformation, mistrust, lack of provider recommendation, and low awareness. Pharmacies were reported the preferred vaccination site, while media and political influences also shaped healthcare decisions.

Conclusions: : Improving adult vaccination rates requires a multifaceted approach addressing both structural and behavioral barriers. Expanding pharmacy-led vaccination services, incorporating digital reminders, and delivering culturally tailored education in high-deprivation areas may improve uptake. Stronger payer–provider–pharmacy collaboration is essential to closing immunization gaps in at-risk adults, particularly those over 50 with chronic conditions.

Sponsorship:: Blue Cross Blue Shield of Kansas City and Pfizer Inc.