All ETDs from UAB

Advisor(s)

Nicole Wright

Committee Member(s)

Gerald McGwin
Jeffrey Curtis
Maria Danila

Jeffrey Curtis

School

School of Public Health

Document Type

Thesis

Department (new version)

Epidemiology

Date of Award

1-1-2025

Abstract

Background/Objective: Clinicians are trusted sources for health advice for people living with autoimmune rheumatic diseases (AIRD), and they may influence the vaccine decision-making during outpatient visits. We aimed to determine factors associated with receipt of a COVID-19 vaccine during the immediate follow-up interval after rheumatology or primary care provider (PCP) clinic visits. Methods: We used the electronic health record (EHR) to conduct a retrospective cohort study of established patients with AIRD at our institution. The primary outcome was presence/absence of COVID-19 vaccination during the 8-day interval after a rheumatology or a PCP clinic visit. We built multivariable logistic regression models to identify factors independently associated vaccine receipt post-visit. We conducted a self-controlled case series (SCCS) analysis to compare receipt of COVID-19 vaccination during the 8-days post-visit “hazard interval” vs. 8-days pre-visit “control interval” as a sensitivity analysis. Results: We identified 2,628 individuals with 2+ rheumatology clinic visits and 493 individuals with 2+ PCP clinic visits, of whom 440 (16.7%) and 119 (24.1%) received a COVID-19 vaccine in the 8-day post-visit interval, respectively. In the multivariable logistic regression model of those with rheumatology visits, older age (OR=1.17, 95% CI 1.03 – 1.33, p=0.02,), Black race (OR=1.49, 95% CI 1.15 – 1.92, p=0.002), and use of glucocorticoids (OR=1.63, 95% CI 1.25 – 2.14, p=0.0004), immunosuppressive (OR=1.40, 95% CI 1.03 – 1.88, p=0.03) medications, and intravenous immunoglobulin (OR=1.91, 95% CI 1.16 – 3.16, p=0.01) were associated with higher odds of COVID-19 vaccination events. Among those with 2+ PCP clinic visits, only older age (OR=1.58, 95% CI 1.22 – 2.06, p=0.0006) and Black race (OR=1.70, 95% CI 1.06 – 2.72, p=0.03) were associated with a post-visit vaccine event. In the SCCS analysis, there were significantly higher rates of vaccination events during the post-visit hazard interval for rheumatology (IRR=1.87, 95% CI 1.62 – 2.18, p<0.0001) and PCP (IRR=3.81, 95% CI 2.75 – 5.36, p<0.0001). Conclusion: In this cohort study of diverse individuals with AIRDs, we found that age, race, and use of certain high-risk medications were associated with COVID-19 vaccination in the post-visit interval. Effective interventions aimed at improving vaccine uptake could be implemented at or soon after a clinic visit.

ProQuest Publication Number

Document on ProQuest

ISBN

9798315795155

Comments

etdadmin_upload_1145968

Download

Available for download on Wednesday, June 02, 2027

Share

COinS