Patterns of healthcare visits and vaccination among adolescents and young adults 16-23-years-old: a retrospective US claims database analysis.

Objective: Several vaccines are recommended for 16-23-year-olds in the United States, but coverage varies widely across these vaccines. Previous studies have indicated that routine healthcare visits are associated with vaccination uptake. This study aimed to describe healthcare visit patterns among 16-23-year-olds to identify challenges and inform opportunities to reach adolescents and young adults for vaccination.

Methods: A descriptive, retrospective database analysis was conducted of commercially insured and Medicaid-insured 16-23-year-olds from 2019-2022 using IQVIA's PharMetrics^® Plus claims database and open-source Longitudinal Prescription/Medical claims databases. The proportion of 16-23-year-olds with healthcare provider (HCP) visits, visit types, provider types involved, visits including vaccination, and specific vaccines delivered were analyzed.

Results: In 2022, 68.2% of commercially insured 16-23-year-olds had ≥1 HCP visit. Most commercially insured and Medicaid-insured individuals with ≥1 HCP visit had sick visits (72.9-80.6%). The proportion of individuals with preventative visits was lower as age increased (commercially insured: 73.2% at 16, 67.4% at 18, 56.3% at 19, and 45.3% at 23 years). Lower proportions of individuals with preventative visits with increasing age were also seen among Medicaid-insured individuals, ranging from 53.7% at 16 years to 28.0% at 23 years. Among 16-18-year-olds with ≥1 HCP or pharmacy visit in 2022, 52.6% in the commercial cohort and 33.0% in the Medicaid cohort had ≥1 visit that involved vaccination; for 19-23-year-olds, these proportions were 34.5% and 25.6%, respectively. Vaccination rates by vaccine type were largely aligned with the ages specified by recommendations, but nonetheless were low.

Conclusion: Approximately one-third of commercially insured 16-23-year-olds did not have an annual HCP visit, and among commercially insured and Medicaid-insured individuals who did have visits, a substantial proportion did not have preventative visits; this proportion was higher with increasing age. The proportions of visits with vaccination were particularly low for 19-23-year-olds. Targeted interventions to promote routine visits, including framing these as opportunities for immunization, may help to increase vaccination uptake; based on the findings of this analysis, these efforts should consider age-specific shifts in health-seeking behaviors.