Hepatitis B vaccination coverage among adults with diagnosed Diabetes Mellitus—Analysis of the 2007 Behavioral Risk Factor Surveillance System (BRFSS)

Background: The United States has ~18 million persons with diagnosed diabetes mellitus (PWDM); up to 75% have non-alcoholic fatty liver disease which can progress to fibrosis. The Advisory Committee on Immunization Practices recommends pneumococcal and influenza vaccines for PWDM, and hepatitis B vaccination for persons with chronic liver and end-stage renal disease and for dialysis patients but not for PWDM without co-morbidities. We analyzed a national database to determine hepatitis B vaccination coverage among PWDM.

Methods: Using the 2007 BRFSS, weighted proportions of self-reported adult hepatitis B vaccination (≥1 dose) were determined by diabetes status and age group. To determine if diabetes was independently correlated with vaccination, a multivariate logistic regression was performed. To determine if PWDM were more likely to receive recommended adult vaccinations, self-reported pneumococcal and influenza vaccination levels were determined.

Results: In 2007, hepatitis B vaccination coverage among PWDM was 21% (95%CI 21%-22%) compared with 32% (31%-32%) in persons without diabetes (PWODM). PWDM aged 20-24 years reported the highest vaccination coverage (64% {50%-78%}); ages ≥70 years reported the lowest (9% {8%-10%}). Multivariate analysis revealed that PWDM were only marginally more likely to be vaccinated than PWODM: OR 1.10 (1.03-1.17). Adult PWDM were more likely to report pneumococcal (49% {48%-50%}) and influenza (61% {60%-62%}) vaccination than PWODM (both P-values <0.05).

Conclusion: Although many PWDM have chronic liver and/or renal disease, they have low hepatitis B vaccination coverage. Given the potential for hepatitis B infection to exacerbate chronic liver disease, strategies should be considered to increase vaccination coverage among PWDM.