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Link-Gelles R, Westreich D, Aiello AE, et al. Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study. SSM Popul Health. 2016;2:587-594doi: 10.1016/j.ssmph.2016.08.005.
Link-Gelles, R., Westreich, D., Aiello, A. E., Shang, N., Weber, D. J., Holtzman, C., Scherzinger, K., Reingold, A., Schaffner, W., Harrison, L. H., Rosen, J. B., Petit, S., Farley, M., Thomas, A., Eason, J., Wigen, C., Barnes, M., Thomas, O., Zansky, S., Beall, B., Whitney, C. G., & Moore, M. R. (2016). Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study. SSM - population health, 2587-594. https://doi.org/10.1016/j.ssmph.2016.08.005
Link-Gelles, Ruth, et al. "Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study." SSM - population health vol. 2 (2016): 587-594. doi: https://doi.org/10.1016/j.ssmph.2016.08.005
Link-Gelles R, Westreich D, Aiello AE, Shang N, Weber DJ, Holtzman C, Scherzinger K, Reingold A, Schaffner W, Harrison LH, Rosen JB, Petit S, Farley M, Thomas A, Eason J, Wigen C, Barnes M, Thomas O, Zansky S, Beall B, Whitney CG, Moore MR. Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study. SSM Popul Health. 2016 Dec;2:587-594. doi: 10.1016/j.ssmph.2016.08.005. PMID: 27668279; PMCID: PMC5033249.
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SSM Popul Health. 2016 Dec;2:587-594. doi: 10.1016/j.ssmph.2016.08.005.

Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study.

SSM - population health

Ruth Link-Gelles, Daniel Westreich, Allison E Aiello, Nong Shang, David J Weber, Corinne Holtzman, Karen Scherzinger, Arthur Reingold, William Schaffner, Lee H Harrison, Jennifer B Rosen, Susan Petit, Monica Farley, Ann Thomas, Jeffrey Eason, Christine Wigen, Meghan Barnes, Ola Thomas, Shelley Zansky, Bernard Beall, Cynthia G Whitney, Matthew R Moore

Affiliations

  1. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA.
  2. Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA.
  3. Minnesota Department of Health, P.O. Box 64975, St. Paul, MN 55164, USA.
  4. Institute for Public Health, University of New Mexico, Emerging Infections Program, 1601 Randolph SE, Suite 1005, Albuquerque, NM 87106, USA.
  5. California Emerging Infections Program, 360 22nd Street, Suite 750, Oakland, CA 94612, USA.
  6. Department of Preventive Medicine, Vanderbilt University School of Medicine, 1500 21st Avenue South, Suite 2600, Nashville, TN 37212, USA.
  7. Department of International Health, Johns Hopkins Bloomberg School of Public Health, 201 W. Preston Street, Baltimore, MD 21201, USA.
  8. New York City Department of Health and Mental Hygiene, 125 Worth St, New York, NY 10013, USA.
  9. Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134, USA.
  10. Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Infection Disease Section, Medical Specialty Care Service Line, Atlanta VA Medical Center, 1670 Clairmont Road, Station 152, Decatur, GA 30033, USA.
  11. Oregon Public Health Division and Oregon Emerging Infections Program, 800 NE Oregon Street, Suite 772, Portland, OR 97232, USA.
  12. Bureau of Epidemiology, Utah Department of Health, 288 N 1460 W, Salt Lake City, UT 84116, USA.
  13. County of Los Angeles Department of Public Health, 313 N Figueroa St, Los Angeles, CA 90012, USA.
  14. Colorado Emerging Infections Program, 4300 Cherry Creek Drive South, Denver, CO 80246, USA.
  15. New York State Department of Health, Corning Tower, Room 651, Empire State Plaza, Albany, NY 12237, USA.
  16. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA.

PMID: 27668279 PMCID: PMC5033249 DOI: 10.1016/j.ssmph.2016.08.005

Abstract

In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the US for prevention of invasive pneumococcal disease in children. Individual-level socioeconomic status (SES) is a potential confounder of the estimated effectiveness of PCV13 and is often controlled for in observational studies using zip code as a proxy. We assessed the utility of zip code matching for control of SES in a post-licensure evaluation of the effectiveness of PCV13 (calculated as [1-matched odds ratio]*100). We used a directed acyclic graph to identify subsets of confounders and collected SES variables from birth certificates, geo-coding, a parent interview, and follow-up with medical providers. Cases tended to be more affluent than eligible controls (for example, 48.3% of cases had private insurance vs. 44.6% of eligible controls), but less affluent than enrolled controls (52.9% of whom had private insurance). Control of confounding subsets, however, did not result in a meaningful change in estimated vaccine effectiveness (original estimate: 85.1%, 95% CI 74.8-91.9%; adjusted estimate: 82.5%, 95% CI 65.6-91.1%). In the context of a post-licensure vaccine effectiveness study, zip code appears to be an adequate, though not perfect, proxy for individual SES.

Keywords: Matched case-control; PCV13; Pneumococcal vaccine; Pneumococcus; Socioeconomic status; Vaccine effectiveness

Conflict of interest statement

Conflicts Dr. Lynfield and Ms. Holtzman report grants from Centers for Disease Control and Prevention, during the conduct of the study. In addition, Dr. Lynfield is an editor for a book on Infectious

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