Pediatric Vaccination and Vaccine-preventable Disease Acquisition: Associations with Care by Complementary and Alternative Medicine Providers

Lois Downey; Patrick T. Tyree; Colleen E. Huebner; William E. Lafferty

Disclosures

Matern Child Health J. 2010;14(6):922-930. 

In This Article

Results

The Vaccination Sample

The insurance companies provided continuous coverage to 11,144 children for whom claims were made during the years of first and second birthday (Table 1). Most children were enrolled in preferred-provider or point-of-service products and lived in metropolitan areas. They were spread relatively evenly over the two genders and three birth years. Most received all health care from conventional providers, with fewer than 4% having visits to any CAM provider. About 30% of the children had other family members with claims for CAM services. Children were significantly more likely to have seen a naturopathic physician if they were enrolled in a health maintenance organization (2.9%) or point-of-service product (2.2%) than if they had preferred-provider (1.5%) or fee-for-service coverage (1.2%; χ2 = 11.37, df = 3, P = .010). By contrast, more preferred-provider (2.8%) than point-of-service (1.7%), fee-for-service (1.5%) or health-maintenance-organization enrollees (0.6%) saw chiropractors (χ2 = 22.56, df = 3, P = .000). Receipt of acupuncture and massage services did not differ significantly by product type. During the years of first and second birthday, about 75% of the enrollees received vaccinations for diphtheria/tetanus or H. influenzae type B, 67% received measles/mumps/rubella vaccinations, and 51% had chickenpox vaccinations.

Predictors of Pediatric Vaccination

Because few enrollees received acupuncture or massage, we excluded these predictors from regression models. After adjustment for insurance company, rates of vaccination for chickenpox increased significantly over the study period; all vaccination types were more likely in urban than in rural areas; and all rates were highest in point-of-service and health-maintenance-organization plans, lower in preferred-provider plans, and lowest among fee-for-service enrollees (Table 2).

Uptake rates for each vaccination type were significantly lower among children who received either chiropractic or naturopathic care and among children whose family members received care from CAM providers than among their counterparts. Compared with children who received all health care from conventional providers, those who saw both conventional and CAM providers had significantly lower rates of all four vaccinations, and rates among children who received care exclusively from CAM providers were lower still.

In multivariate models (Table 3), naturopathic care remained a significant predictor of reduced rates of all vaccinations, and chiropractic care was a significant predictor of all except diphtheria/tetanus. Use of CAM by other family members did not have a significant independent association with vaccination rates—the reduction in the strength of association resulting from confounding of CAM use with product type.

The Disease Acquisition Sample

Our data included information for 213,884 enrollees with at least 1 full year of coverage between the ages of 1 year and 17 years. Over 7% of the enrollees saw a CAM provider, typically a chiropractor, during this period, and about 30% came from families with some use of CAM providers (Table 4). Disease acquisition was low, with just over 1% of the enrollees receiving diagnoses of vaccine-preventable disease during their measurement period. Of the diagnosed cases, 85% involved chickenpox, 7% pertussis, 5% rubella, 2% hepatitis B, 1% mumps, and 1% all other diseases combined.

Predictors of Disease Acquisition

Diagnosis with a vaccine-preventable disease was significantly more likely among enrollees aged 1–17 years who saw a CAM provider during 2000–2003 than among those who used conventional care exclusively: 1.5% versus 1.3%, respectively. In a multivariate model including all five CAM predictors, and with adjustment for the number of years of insurance enrollment during the period, only naturopathy was associated with increased disease acquisition (Table 5).

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