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      Rotavirus vaccine coverage and factors associated with uptake using linked data: Ontario, Canada

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          Abstract

          Background

          In August 2011, Ontario, Canada introduced a rotavirus immunization program using Rotarix vaccine. No assessments of rotavirus vaccine coverage have been previously conducted in Ontario.

          Methods

          We assessed vaccine coverage (series initiation and completion) and factors associated with uptake using the Electronic Medical Record Administrative data Linked Database (EMRALD), a collection of family physician electronic medical records (EMR) linked to health administrative data. Series initiation (1 dose) and series completion (2 doses) before and after the program’s introduction were calculated. To identify factors associated with series initiation and completion, adjusted odds ratios (aOR) and 95% confidence intervals (95%CI) were calculated using logistic regression.

          Results

          A total of 12,525 children were included. Series completion increased each year of the program (73%, 79% and 84%, respectively). Factors associated with series initiation included high continuity of care (aOR = 2.15; 95%CI, 1.61–2.87), maternal influenza vaccination (aOR = 1.55; 95%CI,1.24–1.93), maternal immmigration to Canada in the last five years (aOR = 1.47; 95% CI, 1.05–2.04), and having no siblings (aOR = 1.62; 95%CI,1.30–2.03). Relative to the first program year, infants were more likely to initiate the series in the second year (aOR = 1.71; 95% CI 1.39–2.10) and third year (aOR = 2.02; 95% CI 1.56–2.61) of the program. Infants receiving care from physicians with large practices were less likely to initiate the series (aOR 0.91; 95%CI, 0.88–0.94, per 100 patients rostered) and less likely to complete the series (aOR 0.94; 95%CI, 0.91–0.97, per 100 patients rostered). Additional associations were identified for series completion.

          Conclusions

          Family physician delivery achieved moderately high coverage in the program’s first three years. This assessment demonstrates the usefulness of EMR data for evaluating vaccine coverage. Important insights into factors associated with initiation or completion (i.e. high continuity of care, smaller roster sizes, rural practice location) suggest areas for research and potential program supports.

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          Most cited references29

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          Chi-Square Tests for Goodness of Fit and Contingency Tables

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            Pediatric deaths attributable to complex chronic conditions: a population-based study of Washington State, 1980-1997.

            Advances in medical technology and public health are changing the causes and patterns of pediatric mortality. To better inform health care planning for dying children, we sought to determine if an increasing proportion of pediatric deaths were attributable to an underlying complex chronic condition (CCC), what the typical age of CCC-associated deaths was, and whether this age was increasing. Population-based retrospective cohort from 1980 to 1997, compiled from Washington State annual censuses and death certificates of children 0 to 18 years old. For each of 9 categories of CCCs, the counts of death, mortality rates, and ages of death. Nearly one-quarter of the 21 617 child deaths during this period were attributable to a CCC. Death rates for the sudden infant death syndrome (SIDS), CCCs, and all other causes each declined, but less so for CCCs. Among infants who died because of causes other than injury or SIDS, 31% of the remaining deaths were attributable to a CCC in 1980 and 41% by 1997; for deaths in children 1 year of age and older, CCCs were cited in 53% in 1980, versus 58% in 1997. The median age of death for all CCCs was 4 months 9 days, with substantial differences among CCCs. No overall change in the age of death between 1980 to 1997 was found (nonparametric trend test). CCCs account for an increasing proportion of child deaths. The majority of these deaths occur during infancy, but the typical age varies by cause. These findings should help shape the design of support care services offered to children dying with chronic conditions and their families.
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              Validity of administrative data for identifying patients who have had a stroke or transient ischemic attack using EMRALD as a reference standard.

              Surveillance for stroke/transient ischemic attack (TIA) using administrative data has traditionally been limited to reporting patients who had an acute event and were hospitalized. This underestimates the true prevalence because many events do not result in hospitalization. We examined whether the accuracy of administrative data for identifying prevalent stroke/TIA could be improved by using data from both inpatient and outpatient visits.
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                Author and article information

                Contributors
                Role: Funding acquisitionRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Funding acquisitionRole: MethodologyRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 February 2018
                2018
                : 13
                : 2
                : e0192809
                Affiliations
                [1 ] Public Health Ontario, Toronto, Ontario, Canada
                [2 ] Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
                [3 ] Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
                [4 ] Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
                [5 ] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
                [6 ] Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
                [7 ] Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
                Johns Hopkins Bloomberg School of Public Health, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-8239-0094
                Article
                PONE-D-17-18033
                10.1371/journal.pone.0192809
                5812625
                29444167
                1da83db2-746d-4c81-bbbc-c1d3a7fc8b34
                © 2018 Wilson et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 May 2017
                : 30 January 2018
                Page count
                Figures: 1, Tables: 5, Pages: 18
                Funding
                Funded by: Public Health Ontario
                Award Recipient :
                This work was funded by Public Health Ontario (PHO). This study was also supported by the Institute for Clinical Evaluative Sciences (ICES). Both PHO and ICES are funded by annual grants from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Astrid Guttmann receives salary support from a Canadian Institutes for Health Research Applied Chair in Reproductive and Child Health Services and Policy Research. Karen Tu and Jeff Kwong are supported by Clinician Scientist Awards from the Department of Family and Community Medicine at the University of Toronto. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, PHO, or MOHLTC is intended or should be inferred. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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                The data set from this study is held securely in coded form at the Institute for Clinical Evaluative Sciences (ICES). While data sharing agreements prohibit ICES from making the data set publicly available, access may be granted to those who meet pre-specified criteria for confidential access, available at www.ices.on.ca/DAS. In addition, the full dataset creation plan is available from the authors upon request.

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