Elsevier

Vaccine

Volume 23, Issue 8, 11 January 2005, Pages 1015-1020
Vaccine

Validation of self-reported pneumococcal vaccination in behavioral risk factor surveillance surveys: experience from the sickness prevention achieved through regional collaboration (SPARC) program

https://doi.org/10.1016/j.vaccine.2004.07.039Get rights and content

Abstract

Behavioral risk factor surveillance system (BRFSS) is the primary surveillance tool for the ongoing measurement of state-specific delivery of pneumococcal polysaccharide vaccine. This study is the first validity assessment of self-reported pneumococcal vaccination status in a population-wide BRFSS survey. A subset of respondents to the sickness prevention achieved through regional collaboration (SPARC) BRFSS survey, which was conducted from June to September 1997 in a four-county area were assessed. Self-reporting of pneumococcal vaccination status was validated either by matching to Medicare claims or by reviewing of medical records. Self-reporting of pneumococcal vaccination had a sensitivity of 75% and a specificity of 83%. We conclude that self-reporting of pneumococcal immunization is a moderately sensitive and specific measure and that population-based surveys in the community can be validated when undertaken in collaboration with a local health care agency.

Introduction

Tracking the delivery of pneumococcal polysaccharide vaccine (PPV) to older adults is an important part of a national strategy to assess and expand the provision of the vaccine. One dose of PPV is recommended for persons at increased risk for complications from invasive pneumococcal disease, including all adults aged 65 years and older [1]. The vaccine is considered safe, cost-effective, and potentially cost-saving for preventing bacteremia among older adults [2]. Pneumococcal disease is a cause of significant morbidity and mortality in the United States. The causative agent, Streptococcus pneumoniae, is responsible for approximately 60,000 cases of pneumococcal bacteremia or meningitis and for 6000 deaths annually [3]. In 1997, the year this study was launched, the national objective of Healthy People 2000 was to increase the proportion of older adults receiving influenza and pneumococcal vaccinations to 60%. In Healthy People 2010 this target has been increased to 90% [4]. The 1997 behavioral risk factor surveillance system (BRFSS) survey found that 45.4% of persons aged ≥65 years reported ever receiving a pneumococcal vaccine [5]; in 2002, the level had increased to 62% [6].

BRFSS, a collaborative activity of the Centers for Disease Control and Prevention (CDC) and states, is the leading population-wide surveillance instrument for the ongoing measurement of state-specific PPV delivery. Pneumococcal vaccination status has been asked of respondents in all states in selected BRFSS surveillance years since 1993 [7]. Limited validation analysis has been conducted on responses to this question, and this study is the first to determine the population-wide validity of self-reported pneumococcal vaccination status in a BRFSS survey. The study was undertaken to help interpret self-reported rates of receiving PPV and as a pilot project to determine the feasibility of conducting periodic validation studies that can better track progress toward Healthy People 2010 objectives.

Section snippets

Respondents

Participants in this study were part of a random-digit dialed survey conducted from June to September 1997 among 2241 non-institutionalized civilian respondents aged 50 years and older in a four-county area connecting Connecticut, Massachusetts, and New York. The survey was conducted by sickness prevention achieved through regional collaboration (SPARC), a non-profit health care agency based in Lakeville, Connecticut. SPARC works with regional health care and social service providers to

Results

We located about half of the original SPARC BRFSS survey participants (51.1% = 266/520) (Fig. 1). Of the 254 located eligible respondents, 66% (168/254) agreed to participate and returned written informed consent forms. Ninety-seven percent (164/168) of those providing written consent also provided their Medicare number and/or information about their primary care physicians. Eighty-two percent (80/97) of medical practices contacted provided the requested information. We were able to confirm

Discussion

The primary goal of this study was to assess the validity of self-reported pneumococcal vaccination status as provided to a BRFSS survey. Self-report of pneumococcal vaccination had a sensitivity of 75% and a specificity of 83%. Overall, reliability of self-reports was moderately good with 73% giving identical responses in 1997 and 1999. In addition, 87% reported receiving a pneumococcal vaccination on their consent form within 3 years of documented receipt.

This is the first pneumococcal

Acknowledgements

This study was supported by the Centers for Disease Control and Prevention (CDC). We thank Michael Alderman, M.D.; Chris Maylahn, M.P.H.; David Nelson, M.D., M.P.H.; and Suzanne Smith, M.D., M.P.H.

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