24. An analysis of the National Institutes of Health All of Us Research Database: Sociodemographic Disparities Among Patients Who Received Vaccinations

Abstract Background The National Institutes of Health All of Us (AoU) research program is building a diversified database of 1 million+ adult subjects. With this database, we seek to describe the sociodemographic characteristics of those with documented vaccinations. Methods The AoU recruited subjects ≥ 18 years beginning in 2018. Eligible subjects were subsequently divided into five vaccine cohorts based on their vaccine history [influenza, hepatitis B (HepB), pneumococcal (Pneu) < 65, Pneu ≥ 65, human papillomavirus (HPV)]. The vaccine cohorts were compared to the general AoU cohort. Subjects in the influenza cohort had documented influenza vaccinations from 09/2017-05/2018. Other vaccine cohorts comprised subjects with ≥ 1 lifetime record(s) of vaccination by 12/2018. The Pneu < 65 and ≥ 65 cohorts comprised those who received pneumococcal vaccination before or after (inclusive) 65 years old, respectively. Descriptive statistics for all cohorts were generated using survey and electronic health record (EHR) data. Results We analyzed 315297 subjects in the AoU dataset R2020Q4R2. The cohort sizes were: influenza (n=15346), HepB (n=6323), HPV (n=2125), and Pneu (< 65 n=15217; ≥65 n=15100). For all vaccine cohorts, comparing the 95% confidence intervals (CIs), the proportions of whites and non-Hispanics/Latinos were statistically higher than the general AoU cohort, the largest being from the Pneu ≥ 65 cohort (Table 1). For educational attainment, the Pneu < 65 (36.5%) had the smallest proportion of college or advanced degree graduates while the largest was observed in the Pneu ≥ 65 cohort (59.0%). The proportions of subjects with < &10k in annual household income (AHI) were largest among Pneu < 65 (17.1%) and smallest among Pneu ≥ 65 (3.8%). In contrast, the largest proportion of subjects with ≥ &100k AHI was among Pneu ≥ 65 (25.3%) and the smallest among Pneu < 65 (15.8%). Table 1. Sociodemographic characteristics of subjects in the All of Us research program based on vaccine receipt Conclusion Racial and ethnic disparities in vaccinations were apparent. Pneumococcal vaccination at age 65 years and above was more prevalent among white, non-Hispanic/Latino subjects who were also more educated and affluent. Conversely, those receiving pneumococcal vaccination before age 65 years were less educated and had lower AHI. Disclosures All Authors: No reported disclosures


Session: P-02. Adult Vaccines
Background. Adults ≥ 50 years of age (YOA) are at increased risk of herpes zoster (HZ), a condition which can cause long-term pain and discomfort. In this analysis, we assessed the burden of pain associated with HZ and its interference with activities of daily living (ADL) in patients ≥ 50 YOA.
Methods. ZOE-50 (NCT01165177) and ZOE-70 (NCT01165229) were phase III, observer-blind, placebo-controlled, 1:1 randomized studies in adults ≥ 50 YOA (ZOE-50) and ≥ 70 YOA (ZOE-70) who received 2 doses of the adjuvanted recombinant zoster vaccine or placebo, 2 months apart. To correctly evaluate HZ pain, the analysis was performed only on the placebo groups data of ZOE-50 (≥ 50 YOA) and pooled ZOE-50/70 (≥ 70 YOA pooled data) in the modified total vaccinated cohort (mTVC, primary population for efficacy analysis) HZ-confirmed cases. HZ pain and interference with ADL was assessed by the Zoster Brief Pain Inventory (ZBPI) instrument completed daily by patients for the first 28 days and then weekly until resolution. Time to resolution of clinically significant pain was analyzed using Kaplan Meier methods. We estimated the cumulative area under curve (AUC) of the ZBPI worst pain score and the ZBPI ADL score up to 182 days post-HZ rash onset. A high AUC reflects a higher severity/longer duration of pain.
Conclusion. Analysis of data provided by patients with confirmed HZ shows that the burden of HZ pain is high and is associated with interference on patients' ADL. Background. The National Institutes of Health All of Us (AoU) research program is building a diversified database of 1 million+ adult subjects. With this database, we seek to describe the sociodemographic characteristics of those with documented vaccinations.
Methods. The AoU recruited subjects ≥ 18 years beginning in 2018. Eligible subjects were subsequently divided into five vaccine cohorts based on their vaccine history [influenza, hepatitis B (HepB), pneumococcal (Pneu) < 65, Pneu ≥ 65, human papillomavirus (HPV)]. The vaccine cohorts were compared to the general AoU cohort. Subjects in the influenza cohort had documented influenza vaccinations from 09/2017-05/2018. Other vaccine cohorts comprised subjects with ≥ 1 lifetime record(s) of vaccination by 12/2018. The Pneu < 65 and ≥ 65 cohorts comprised those who received pneumococcal vaccination before or after (inclusive) 65 years old, respectively. Descriptive statistics for all cohorts were generated using survey and electronic health record (EHR) data.
Results. We analyzed 315297 subjects in the AoU dataset R2020Q4R2. The cohort sizes were: influenza (n=15346), HepB (n=6323), HPV (n=2125), and Pneu (< 65 n=15217; ≥65 n=15100). For all vaccine cohorts, comparing the 95% confidence intervals (CIs), the proportions of whites and non-Hispanics/Latinos were statistically higher than the general AoU cohort, the largest being from the Pneu ≥ 65 cohort (Table 1). For educational attainment, the Pneu < 65 (36.5%) had the smallest proportion of college or advanced degree graduates while the largest was observed in the Pneu ≥ 65 cohort (59.0%). The proportions of subjects with < $10k in annual household S136 • OFID 2021:8 (Suppl 1) • Abstracts income (AHI) were largest among Pneu < 65 (17.1%) and smallest among Pneu ≥ 65 (3.8%). In contrast, the largest proportion of subjects with ≥ $100k AHI was among Pneu ≥ 65 (25.3%) and the smallest among Pneu < 65 (15.8%). Table 1. Sociodemographic characteristics of subjects in the All of Us research program based on vaccine receipt Conclusion. Racial and ethnic disparities in vaccinations were apparent. Pneumococcal vaccination at age 65 years and above was more prevalent among white, non-Hispanic/Latino subjects who were also more educated and affluent. Conversely, those receiving pneumococcal vaccination before age 65 years were less educated and had lower AHI.
Disclosures. Background. According to the Centers for Disease Control and Prevention (CDC), during the 2019-20 U.S. influenza season, influenza resulted in almost 180,000 hospitalizations and over 13,000 deaths in adults ≥ 65 years. The current study evaluated the relative vaccine effectiveness (rVE) of adjuvanted trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD), against influenza-related hospitalizations/emergency room (ER) visits, all-cause hospitalizations and hospitalizations/ER visits for cardio-respiratory disease (CRD) among adults ≥65 years for the 2019-20 influenza season.

Methods.
A retrospective cohort analysis of older adults (≥ 65 years) was conducted using IQVIA's professional fee, prescription claims and hospital charge master data in the U.S. Baseline characteristics included age, gender, payer type, geographic region, Charlson Comorbidity Index (CCI), comorbidities, indicators of frail health status, and pre-index hospitalization rates. To avoid any influenza outcome misclassification with COVID-19 infection, the study period ended March 7, 2020. Adjusted analyses were conducted through inverse probability of treatment weighting (IPTW) to control for selection bias. Poisson regression was used to estimate the adjusted pairwise rVE against influenza-related hospitalizations/ER visits, all-cause hospitalizations and any hospitalization/ER visit for CRD. An unrelated negative control outcome, urinary tract infection (UTI) hospitalization was included.