Determinants of Hepatitis B vaccination amoung adults in the United States: NHANES 1999-2006

Purpose: The primary objective of this study was to estimate the prevalence of vaccination and HBV infection status of adults and to evaluate the trend in self reported vaccination and seroprevalence for Hepatitis B for this population. Additionally, we assessed the association between vaccination rates, seroprevalence, demographic, and socioeconomic characteristics. Methods: Eight years, 1999-2006, of National Health and Nutrition Examination Survey (NHANES) data were used. NHANES participants aged 20-59 years who contributed data via the household interview and laboratory component were eligible for this study. The vaccination status was identified through self-report and serologic markers. All analyses were completed using SAS 9.2. Results: Unvaccinated adults were more likely to be male, over the age of 40, Non-Hispanic white, born in the US, married, have some education beyond high school, have a household income greater than $20,000, live in a smaller household, have health insurance coverage, and a source of usual care. High risk adults comprised about 16% of adults who had received at least one dose of the Hepatitis B vaccine. Almost half of adults who reported receiving all three doses of the vaccine tested negative for immunity. Compared to adults in 1999-2000, adults were twice as likely to report vaccination in 2005-2006. Conclusions: Only 32% of high risk adults are vaccinated. The rise in vaccination rates in young adults is mostly related to childhood immunization strategies. More targeted interventions are needed to educate and vaccinate the adult population and to create a means for identifying those at risk and those already vaccinated.