番茄社区

BALTIMORE -- The preventive care mandate of the Affordable Care Act (ACA) led to the timely administration of the full diphtheria, tetanus, and acellular pertussis (DTaP) vaccine to young children, researchers reported here.

DTaP vaccination rates improved for infants following implementation of the ACA, with the largest increase in the fourth dose of vaccine (P<0.001), reported , direct of health outcomes at Thomson Reuters in Ann Arbor, Mich., and colleagues.

Not only were kids receiving more complete doses of the vaccine, they were receiving them on time, with the largest increases among the poorest families, the authors reported at Pediatric Academic Societies (PAS) annual meeting.

Children in families <200% below the federal poverty level saw a 5.5% increase in on-time vaccination rates for the fourth dose of DTaP vaccine, with a 5.0% increase in children at 200%-300% of the federal poverty level and a 2.0% increase in children at ≥400% of the federal poverty level, they said.

In addition, cost-sharing levels declined significantly after ACA implementation, the authors noted.

, of Montefiore Medical Center in New York City said that there were significant clinical implications to these findings because timely vaccination for pertussis is critical to preventing the condition in infants.

"We know when vaccinations are delayed in children, it simply expands the interval of time in which they're at risk for contracting a disease, so timely vaccination is really critical to young infants," said Madan, who was not involved with the research, to 番茄社区. "The fact that we're seeing better adherence to timely vaccination, particularly in low resource health settings, is an important clinical implication."

Gibson's team decided to examine the effect of the preventive care mandate on childhood vaccination rates. Using the , which includes data from 100 large employers and health plans in the U.S., they constructed a birth cohort of children born from 2007 to 2013 in the 33 states where vaccines were recorded consistently by the child's health plan (about 1 million privately insured children). The first vaccine was given no later than 93 days of age.

"The ACA was passed in 2010 and sought to encourage preventive service use, including vaccinations, by eliminating cost sharing, but limited data exists on the effects of the ," Gibson said.

Following implementation of the ACA, cost-sharing levels declined considerably, though Gibson noted they never reached $0, because of a grandfathering clause, which allows health plans to continue to charge cost-sharing amounts for wellness visits -- plus vaccines -- if they never changed their benefits in any material way.

But higher cost sharing was associated with lower percentage of timely vaccination. To illustrate the relationship between cost-sharing, income level and the ACA, Gibson examined the percentage of children predicted to be up-to-date on their DTaP vaccination with a higher cost-sharing plan in a lower income area prior to the ACA (84.2%) and compared that with the percentage of predicted up-to-date children with a lower cost-sharing plan in a higher income area after the ACA (92%).

Madan said that the missing piece to this data is how the ACA has impacted the uptake of pertussis vaccination rates for adults, who are "reservoirs" for the disease.

"Vaccinating children has always been easier than vaccinating adults because children see their doctor at regularly scheduled intervals, but we don't really have great system in place to approach vaccination from a family standpoint," she said.

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