Набор на работу в клиники Версус на уровне общин для экспериментальной программы профилактики детского диабета, Восточный Гарлем, Нью-Йорк, 2011-2012.

Summary

What is already known on this topic?

Surveys are commonly used for surveillance of health behaviors, including receipt of vaccinations. However, little is known about the accuracy of survey-based self-reports of vaccination status.

What is added by this report?

In this study of patients considered at elevated risk for hepatitis A, hepatitis B, or both, we found moderate over-reporting of vaccination for hepatitis A and hepatitis B when self-report was compared with vaccination records in the electronic health record and the Colorado Immunization Information System.

What are the implications for public health practice?

Accuracy of self-report was in an acceptable range for use in development of vaccine policies and public health actions for improving hepatitis A and B vaccination coverage.

Objective

Hepatitis A (HepA) and B (HepB) are vaccine-preventable infections. HepA is usually acute and can be severe. HepB can be chronic, increasing the risk of liver failure and cancer. HepA is usually transmitted through the fecal–oral route or through contaminated food or water; HepA vaccination recommendations for adults are risk-based, focusing on sexual contact, drug use, occupational risk, homelessness, HIV, and chronic liver disease ( 1 ). HepB is transmitted through blood. From 1982 until 2022, HepB vaccination was recommended for high-risk adults, which included those with drug use and multiple sexual partners. Starting in 2022, HepB vaccination was expanded as a universal vaccination recommendation for adults through age 59 years ( 2 ).

Accurate data are needed to monitor vaccination coverage. In the US, no single comprehensive source of vaccination information exists. Large national surveys are used, but little is known about the accuracy of survey-based self-reports of vaccination status. The National Health Interview Survey (NHIS) has been used to estimate hepatitis vaccination coverage ( 3 , 4 ). Most recently, in 2021, self-reported hepatitis vaccination coverage ranged from 25% to 40%, with higher coverage among those with risk factors and higher coverage for HepB compared with HepA ( 4 ).

Our aim was to estimate the sensitivity, specificity, net bias, and relative net bias of self-reported hepatitis vaccination status among adults at increased risk for HepA, HepB, or both. This study can be situated within the Total Survey Error (TSE) framework, which conceptualizes error in survey estimates as arising from multiple sources. Our study focused on measurement error ( 5 ).

Methods

This study was conducted in Denver Health, the public safety-net health system for the city and county of Denver, Colorado, that serves 177,000 patients annually, and Kaiser Permanente Colorado, a membership-based, integrated health system that serves more than 500,000 members in the front-range urban corridor where more two-thirds of Colorado’s population resides.

Using electronic health records (EHRs) and International Classification of Diseases (ICD) 9 and ICD 10 codes, we identified current patients aged 30 years or older with risk factors for HepA (eg, illicit drug use), HepB (eg, history of sexually transmitted diseases), or both (eg, chronic liver disease) ( Appendix ). People were considered to be vaccinated for HepA if the EHR recorded at least 2 doses and for HepB if the EHR recorded 3 or more standard doses or 2 or more adjuvanted doses ( 6 ). We randomly sampled equal proportions of vaccinated and unvaccinated people across the 2 systems. Patients were eligible if they spoke English or Spanish, did not have a cognitive impairment or disability that prevented them from responding, and had at least 1 valid form of contact (email, postal address, or telephone).

The survey, introduced as a survey about community health ( Table 1 ), was available in English and Spanish. Questions were drawn from the 2021 NHIS (receipt of vaccine), 2018 NHIS (number of doses), and 2021 Behavioral Risk Factor Surveillance System (BRFSS; demographic questions) ( Table 1 ) ( 7 – 9 ). Survey administration was during January through April 2022. Contacts included a postal letter, up to 3 email reminders to complete the survey online, up to 8 telephone calls to complete the survey by telephone, and a final email reminder. Respondents received a $10 gift card for participating.

Table 1 Survey Introduction and Question Script Used to Assess Receipt of Hepatitis A and B Vaccination, Survey of Colorado Adults at Increased Risk for Hepatitis A and B, 2022 Survey component Wording Survey introduction in invitation letter (postal mail and email)
Dear [name]:
I’m writing to let you know that [Healthcare System] is working with the Colorado School of Public Health at the University of Colorado and the national Centers for Disease Control and Prevention (CDC) in a research study of health and health practices. You have been randomly selected from among our patients at [Healthcare System] to participate in the research study. [Site Principal Investigator] at [Healthcare System] is working with the study team. [Healthcare System] recently sent a letter to you at your home address about this study.
Your participation in the research study is important. The findings will be used to improve the health of your community and our nation. It is important for the study to have a high response rate to have valid results. We at [Healthcare System] encourage you to participate.

Please read the following information about this study:

We are asking you to complete a survey that will take only about 7 minutes of your time.
The study will give you a $10 electronic gift card if you complete the survey . This will be emailed or mailed to you within 2–3 weeks after you complete the survey.
You can complete the survey online by going to the link at the end of this letter. Or you can complete the survey over the phone . To complete the survey over the phone, you can simply wait, and an interviewer will call you. Or, you can call the number at the bottom of this letter. You will be called from the University of Wyoming, who is also a partner in this study.
Participating in this research is completely voluntary . You do not have to answer any survey question you do not want to answer. You can end the survey at any time.

All the information you give will be kept private . The results will not be connected to your name and will not be given to your health care provider.

If you have any questions about the study or your rights as a research participant, you can call the principal investigator of the study at the Colorado School of Public Health, [name and phone number]. Or, you can call the Colorado Multiple Institutional Review Board, which oversees the safety of research studies [phone number].

If you decide that you do not want to participate and do not want to be contacted by phone for this survey, please send an email message to [email address] or leave a voicemail message at [phone number]. Please remember to include your name, the access code below in this letter, and the words “opt-out.”
By agreeing to participate in the survey, you are agreeing to be a part of this research. The data we collect will be used for this study and may also be used for future research. If it is used for future research, all information that could identify you will be removed.
I hope you will consider completing the survey. This will help improve the health of our community and nation.
Survey description in introduction to survey (telephone version)
We are offering a $10 gift card for a short 7–10 minute survey about the health and health practices of Colorado residents. The survey is part of a research project conducted by the Colorado School of Public Health, your health care provider [Healthcare System] and the Centers for Disease Control and Prevention, also known as the CDC.
[Healthcare System] recently sent you a letter to let you know that you have been randomly selected to participate in this research and that we would be calling. This call may be recorded for quality purposes. May I continue?
Your participation in this survey is important because it serves as a way to improve the health of your community and our nation. If you choose to participate, your confidential responses will help provide meaningful information about public health topics.
Survey description in introduction to survey (internet version)
Thank you for logging into this survey about health and health practices in Colorado. If you complete the survey, you will be sent a $10 electronic gift card. This will be emailed to you within 2–3 weeks after you complete the survey.
This survey is part of a research project being conducted by the Colorado School of Public Health, in collaboration with [Healthcare System] and the Centers for Disease Control and Prevention (CDC).
Your participation in this survey is important because it serves as a way to improve the health of your community and our nation. If you choose to participate, your confidential responses will help provide meaningful information about public health topics.
Assessment of hepatitis A vaccination (source: NHIS 2021)
The hepatitis A vaccine is given in two separate doses. Although it can be given as a combination vaccine with hepatitis B, it is different from the hepatitis B vaccine.
Have you EVER received the hepatitis A vaccine?

Read if necessary for telephone survey; provided to all for internet survey: The hepatitis A vaccine has been available since 1995. It is routinely given to some children starting at 1 year of age and to some adults and people who travel outside the United States.
Number of hepatitis A shots received (source: NHIS 2018)
How many hepatitis A shots did you receive?
Assessment of hepatitis B vaccination (source: NHIS 2021)
The hepatitis B vaccine is given in three separate doses. Although it can be given as a combination vaccination with hepatitis A, it is different from the hepatitis A vaccine.
Have you EVER received the hepatitis B vaccine?

Read if necessary for telephone survey; provided to all for internet survey: The hepatitis B vaccine has been available since 1991. It is recommended for newborn infants, adolescents, and people such as health care workers, who may be exposed to the hepatitis B virus.
Number of hepatitis B shots received (source: NHIS 2018) Did you receive at least 3 doses of the hepatitis B vaccine or less than 3 doses? Abbreviation: NHIS, National Health Interview Survey.

Survey Introduction and Question Script Used to Assess Receipt of Hepatitis A and B Vaccination, Survey of Colorado Adults at Increased Risk for Hepatitis A and B, 2022

Abbreviation: NHIS, National Health Interview Survey.

Unequal sampling probabilities were accounted for by using sampling weights based on each stratum’s eligible population and number of respondents. We used SAS PROC SURVEYFREQ to assess sensitivity, specificity, net bias, and relative net bias (SAS Institute, Inc) ( 10 ). Sensitivity and specificity were calculated at the individual level by comparing each respondent’s self-reported vaccination status with the criterion standard. The criterion standard included vaccination information from the EHR, supplemented with records from the Colorado Immunization Information System (CIIS), which compiles data on vaccines received throughout Colorado. Net bias is a population-level summary, calculated as the self-reported vaccination coverage at the population level minus the criterion standard vaccination coverage. Relative net bias is net bias divided by the criterion standard vaccination, multiplied by 100. Survey responses of “don’t know” for vaccination status or number of doses received were excluded (complete cases approach), which is consistent with analysis methods used in published reports of self-reported vaccination status in national surveys. This approach treats uncertain responses as missing and therefore does not distinguish between misreporting and uncertainty.

The Colorado Multiple Institutional Review Board approved the study.

Results

After removing 3 ineligible patients, the HepA sample included 492 adults; after removing 8 ineligible patients, the HepB sample included 510 adults. Response rates were 38.2% (HepA) and 40.0% (HepB). For HepA, response status was significantly related to age and health care system ( Table 2 ). For HepB, response status was related to age, race and ethnicity, study site, and insurance type. Response status was not significantly related to vaccination status for HepA or HepB.

Table 2 Characteristics of Respondents and Comparison to Nonrespondents, Survey of Colorado Adults at Increased Risk for Hepatitis A and B, 2022
Hepatitis A risk group survey response (N = 492) Hepatitis B risk group survey response (N = 510) Variable No, % (n) Yes, % (n)
P value a
No, % (n) Yes, % (n)
P value a

Overall
61.8 (304) 38.2 (188) NA 60.0 (306) 40.0 (204) NA
Sex
Female 43.1 (131) 42.6 (80) .91 49.3 (151) 47.5 (97) .69 Male 56.9 (173) 57.4 (108) 50.7 (155) 52.5 (107)
Age group, y
30–49 38.2 (116) 33.0 (62) .008 22.9 (70) 20.1 (41) .02 50–64 37.2 (113) 29.3 (55) 42.8 (131) 33.3 (68) ≥65 24.7 (75) 37.8 (71) 34.3 (105) 46.6 (95)
Race and ethnicity
Non-Hispanic Black 12.5 (38) 11.7 (22) .42 13.1 (40) 10.8 (22) .02 Non-Hispanic White or Other 60.9 (185) 66.5 (125) 50.3 (154) 62.7 (128) Hispanic 26.6 (81) 21.8 (41) 36.6 (112) 26.5 (54)
Study site
Large, safety-net, urban 50.0 (152) 38.8 (73) .02 54.2 (166) 34.8 (71) <.001 Integrated health care organization 50.0 (152) 61.2 (115) 45.8 (140) 65.2 (133)
Insurance type
Medicare 34.2 (104) 41.0 (77) .44 40.2 (123) 52.0 (106) .04

Medicaid 33.9 (103) 28.2 (53) 26.5 (81) 18.1 (37) HMO or commercial 27.6 (84) 27.1 (51) 24.5 (75) 23.5 (48) Other, unknown, or uninsured
b

4.3 (13) 3.7 (7) 8.8 (27) 6.4 (13)
Vaccinated based on criterion standard c

Yes 49.7 (151) 56.4 (106) .15 46.1 (141) 53.9 (110) .08 No 50.3 (153) 43.6 (82) 53.9 (165) 46.1 (94)
Education level
High school graduate/GED or less — d
27.8 (52) NA — d
30.0 (61) NA Some college or technical school — d
32.1 (60) — d
27.6 (56) College graduate or more — d
40.1 (75) — d
42.4 (86)
Annual household income, $ e

<75,000 — d
68.3 (114) NA — d
66.9 (121) NA ≥75,000 — d
31.7 (53) — d
33.1 (60) Abbreviations: GED, general educational diploma; HMO, health maintenance organization; NA, not applicable. a
P value based on χ 2 test. b Other insurance includes self-pay, Veterans Affairs, Tricare, correctional, and dual-eligible. c Criterion standard included vaccination information from the electronic health record supplemented with records from the Colorado Immunization Information System, which compiles vaccines received from across Colorado. d Data collected only for survey respondents. e For hepatitis A risk group, 21 were missing household income (11%). For hepatitis B risk group, 23 were missing household income (11%).

Characteristics of Respondents and Comparison to Nonrespondents, Survey of Colorado Adults at Increased Risk for Hepatitis A and B, 2022

Abbreviations: GED, general educational diploma; HMO, health maintenance organization; NA, not applicable.

P value based on χ 2 test.

Other insurance includes self-pay, Veterans Affairs, Tricare, correctional, and dual-eligible.

Criterion standard included vaccination information from the electronic health record supplemented with records from the Colorado Immunization Information System, which compiles vaccines received from across Colorado.

Data collected only for survey respondents.

For hepatitis A risk group, 21 were missing household income (11%). For hepatitis B risk group, 23 were missing household income (11%).

Vaccination coverage for HepA based on the criterion standard for the respondent population (weighted) was 16.1%, which was one-third higher than the EHR vaccination coverage for the source population (11.7%), in part demonstrating the influence of incorporating vaccination information from the CIIS ( Table 3 ). After removing survey respondents who reported they “don’t know” whether they have been vaccinated for HepA, the criterion standard vaccination coverage was 14.6%. Self-reported vaccination status for these people was higher, at 20.2%, resulting in a net bias of 5.6% (relative net bias 38.6%), which indicates over-reporting of vaccination. Sensitivity was 52.5% and specificity was 85.3%.

Table 3 Vaccination Coverage Estimates and Accuracy Statistics for Self-Report of Vaccination Status, Survey of Colorado Adults at Increased Risk for Hepatitis A and B, 2022 Characteristic Hepatitis A (2 doses) Hepatitis B (3 doses) Source population, n a
35,262 84,079 EHR vaccination coverage for source population (%) a
11.7 11.1 Sampled population, n a
492 510 Respondent population, n a
188 204 Criterion standard vaccination coverage for respondent population, weighted % b
16.1 22.3 Respondents who said they “don’t know” their vaccination status, weighted % 35.4 35.6 For those who said “don’t know,” proportion vaccinated per criterion standard, weighted % 19.0 21.7 Respondent population after removing those who said “don’t know,” n a
115 129 Criterion standard vaccination coverage for surveyed population after removing those who said “don’t know,” weighted % b
14.6 22.6 Self-reported vaccination after removing those who said “don’t know,” weighted % 20.2 29.1 Sensitivity, weighted % (95% CI) 52.5 (39.4–65.7) 43.4 (28.6–58.2) Specificity, weighted % (95% CI) 85.3 (75.9–94.8) 75.1 (64.0–86.2) Net bias estimate, weighted % c
5.6 6.5 Relative net bias, weighted % c
38.6 28.6 Abbreviation: EHR, electronic health record. a Data are unweighted. b The criterion standard included vaccination information from the EHR supplemented with records from the Colorado Immunization Information System, which compiles vaccines received from across Colorado. c Net bias was calculated as self-reported vaccination coverage minus criterion standard vaccination coverage. Relative net bias was calculated as (net bias/criterion standard vaccination coverage) × 100.

Vaccination Coverage Estimates and Accuracy Statistics for Self-Report of Vaccination Status, Survey of Colorado Adults at Increased Risk for Hepatitis A and B, 2022

Abbreviation: EHR, electronic health record.

Data are unweighted.

The criterion standard included vaccination information from the EHR supplemented with records from the Colorado Immunization Information System, which compiles vaccines received from across Colorado.

Net bias was calculated as self-reported vaccination coverage minus criterion standard vaccination coverage. Relative net bias was calculated as (net bias/criterion standard vaccination coverage) × 100.

Vaccination coverage for HepB based on the criterion standard for the respondent population (weighted) was 22.3%, which was double the EHR vaccination coverage for the source population (11.1%). After removing survey respondents who reported they “don’t know” whether they have been vaccinated for HepB, the criterion standard vaccination coverage was essentially unchanged at 22.6%. Self-reported vaccination status for these people was higher, at 29.1%, resulting in a net bias of 6.5% (relative net bias 28.6%). Sensitivity was 43.4% and specificity was 75.1%.

Discussion

In this study conducted in 2 large health care systems, sensitivity of self-reported vaccination status was low and specificity was moderately high for both HepA and HepB vaccination, indicating that self-report was more accurate for identifying unvaccinated people than vaccinated people. Because the source population was largely unvaccinated, specificity had a greater impact than sensitivity on net bias, resulting in vaccination estimates based on self-report being 5 to 7 percentage points higher than records-based estimates. Using CIIS data increased the records-based estimates by 4 to 11 percentage points over EHR alone, showing the importance of access to records outside of the current medical home.

One previous study examined this question in a single closed health system in the eastern US where the population was primarily non-Hispanic White and insured; that study did not supplement EHR data with immunization information systems data ( 11 ). That study also found positive net bias, with patient self-report somewhat more accurate for HepA compared with HepB vaccination.

This study has limitations. Vaccinations received at health care facilities that did not report to the CIIS at the time the vaccination was given, and vaccines that were received in another state, were not included, resulting in underreporting of true status in the criterion standard. The generalizability of this study may be limited because it was conducted in a single state. However, we sampled from 2 large health care systems that serve both insured and uninsured patients across a wide range of sociodemographic backgrounds. We sampled only patients who had at least 1 valid form of contact. Thus, our findings apply to adults who are reachable within these health care systems and may not be generalizable to people who are less connected to care. Comparison of respondents with nonrespondents shows some differences in response status by demographic group. Our response rate was similar to that of the BRFSS (43.7%) and reflects the declining survey response rates observed over recent decades ( 12 , 13 ). While working to increase response rates may be necessary, as Olson has pointed out, increasing the response rate through incentives or intensive contact methods could contribute to increased measurement error bias because respondents who are difficult to reach may be less accurate in reporting their vaccination status ( 5 ). Our estimates apply to these specific survey questions and this survey context, and accuracy of reporting may differ for other vaccine questions, other populations, or differently framed surveys. Additionally, our complete-case approach excluded respondents who answered “don’t know.” As discussed by Olson, treating uncertain responses as missing can confound uncertainty and item nonresponse with misreporting, and may also mix compositional differences among those with missing or uncertain responses with measurement error among complete cases ( 5 ). As a result, our accuracy estimates pertain to respondents providing definitive yes or no answers.

From a clinical perspective, our results suggest that what patients report to their clinicians may not be accurate. One implication is the need to develop better vaccination documentation systems, including across state jurisdictions. In the absence of documentation of vaccination and lack of certainty from the patient, the best clinical decision may be to offer to vaccinate.

In conclusion, although there was positive net bias, both the self-report and records-based coverage estimates for HepA and HepB vaccinations were low (<30%), and the differences between them were small enough that using either data source would lead to similar policy recommendations and strategies for addressing undervaccination. Thus, we conclude that estimates of vaccination based on self-report surveys may be sufficiently accurate for use in the development of public health actions for HepA and HepB vaccinations. Framed within the TSE perspective, although self-report of vaccination in surveys may be relatively unbiased, survey data may be affected by other biases that were not addressed by our study, including incomplete sample frame coverage and nonresponse. Although survey data may be adequate for estimating population coverage, individual-level analyses could be biased because of misclassification of vaccination status. Due to the lack of a centralized source of vaccination records in the US, surveys remain a necessary and valuable mechanism for population-level vaccination surveillance ( 14 ).

Acknowledgments

The authors declare no potential conflicts of interest with respect to the research, authorship, or publication of this article. This study received funding from the Centers for Disease Control and Prevention, through the Rocky Mountain Prevention Research Center, cooperative agreement no. U48DP006399, Special Interest Project 20-008. No copyrighted material, surveys, instruments, or tools were used in the research described in this article.

The authors gratefully acknowledge the contributions of the Wyoming Survey & Analysis Center, which implemented the survey for this study, and the CIIS, which provided vaccination data.

ICD 9/ICD 10 Codes Used to Sample Adults With Increased Risk for Hepatitis A and B, Colorado, 2022

Condition ICD 9 code ICD 10 code
At risk for hepatitis A and hepatitis B

Chronic liver disease
Chronic liver disease and cirrhosis
571

Alcoholic fatty liver
571.0
K70.0
Alcoholic hepatitis

K70.1
Alcoholic hepatitis without ascites

K70.10
Alcoholic hepatitis with ascites

K70.11
Alcoholic fibrosis and sclerosis of liver

K70.2
Alcoholic cirrhosis of the liver
571.2
K70.3
Alcoholic cirrhosis of liver without ascites

K70.30
Alcoholic cirrhosis of liver with ascites

K70.31
Alcoholic hepatic failure

K70.4
Alcoholic hepatic failure without coma

K70.40
Alcoholic hepatic failure with coma

K70.41
Alcoholic liver disease, unspecified

K70.9
Toxic liver disease

K71
Toxic liver disease with cholestasis

K71.0
Toxic liver disease with hepatic necrosis

K71.1
Toxic liver disease with hepatic necrosis, without coma

K71.10
Toxic liver disease with hepatic necrosis, with coma

K71.11
Toxic liver disease with chronic persistent hepatitis

K71.3
Toxic liver disease with chronic lobular hepatitis

K71.4
Toxic liver disease with chronic active hepatitis

K71.5
Toxic liver disease with chronic active hepatitis without ascites

K71.50
Toxic liver disease with chronic hepatitis with ascites

K71.51
Toxic liver disease with hepatitis, not elsewhere specified

K71.6
Toxic liver disease with fibrosis and cirrhosis of liver

K71.7
Toxic liver disease with other disorders of the liver

K71.8
Toxic liver disease, unspecified

K71.9
Hepatic failure, not elsewhere classified

K72
Chronic hepatic failure

K72.0
Chronic hepatic failure without coma

K72.10
Chronic hepatic failure with coma

K72.11
Hepatic failure, unspecified

K72.9
Hepatic failure, unspecified without coma

K72.90
Hepatic failure, unspecified with coma

K72.91
Chronic hepatitis, not elsewhere classified

K73
Chronic persistent hepatitis, not elsewhere classified

K73.0
Chronic lobular hepatitis, not elsewhere classified

K73.1
Chronic active hepatitis, not elsewhere classified

K73.2
Other chronic hepatitis, not elsewhere classified

K73.8
Alcoholic liver damage, unspecified
571.3

Chronic hepatitis, unspecified
571.40
K73.9
Fibrosis and cirrhosis of liver

K74
Other and unspecified cirrhosis of liver

K74.6
Unspecified cirrhosis of liver

K74.60
Other cirrhosis of liver

K74.69
Hepatic fibrosis

K74.0
Hepatic sclerosis

K74.1
Hepatic fibrosis and hepatic sclerosis

K74.2
Chronic persistent hepatitis
571.41

Autoimmune hepatitis
571.42
K75.4
Other
571.49

Cirrhosis of the liver without mention of alcohol
571.5

Biliary cirrhosis
571.6

Primary biliary cirrhosis

K74.3
Secondary biliary cirrhosis

K74.4
Biliary cirrhosis, unspecified

K74.5
Nonspecific reactive hepatitis

K75.2
Granulomatous hepatitis, not elsewhere classified

K75.3
Other chronic nonalcoholic liver disease
571.8

Unspecified chronic liver disease without mention of alcohol
571.9

Hepatic coma
572.2

Portal hypertension
572.3
K76.6
Hepatorenal syndrome
572.4
K76.7
Other sequelae of chronic liver disease
572.8

Other disorders of the liver
573

Chronic passive congestion of the liver
573.0
K76.1
Other specified inflammatory liver diseases

K75.8
Nonalcoholic steatohepatitis

K75.81
Other specified inflammatory liver diseases

K75.89
Other diseases of the liver

K76
Fatty(change of liver), not elsewhere classified

K76.8
Central hemorrhagic necrosis of liver

K76.2
Infarction of liver

K76.3
Peliosis hepatitis

K76.4
Hepatic veno-occlusive disease

K76.5
Viral hepatitis B with hepatic coma
070.2

Viral hepatitis B without mention of hepatic coma
070.3

Other specified viral hepatitis with hepatic coma
070.4

Acute or unspecified hepatitis C with hepatic coma
070.41

Hepatitis delta without mention of active hepatitis B disease with hepatic coma
070.42

Hepatitis E with hepatic coma
070.43

Chronic hepatitis C with hepatic coma
070.44

Other specified viral hepatitis with hepatic coma
070.49

Other specified viral hepatitis without mention of hepatic coma
070.5

Acute or unspecified hepatitis C without mention of hepatic coma
070.51

Hepatitis delta without mention of active hepatitis B disease or hepatic coma
070.52

Hepatitis E without mention of hepatic coma
070.53

Chronic hepatitis C without mention of hepatic coma
070.54

Other specified viral hepatitis without mention of hepatic coma
070.59

Unspecified viral hepatitis with hepatic coma
070.6

Unspecified viral hepatitis without mention of hepatic coma
070.9

Chronic viral hepatitis

B18
Chronic viral hepatitis B with delta agent

B18.0
Chronic viral hepatitis B without delta agent

B18.1
Chronic viral hepatitis C

B18.2
Other chronic viral hepatitis

B18.8
Chronic viral hepatitis, unspecified

B18.9
Unspecified viral hepatitis

B19
Unspecified viral hepatitis with hepatic coma

B19.0
Unspecified viral hepatitis B

B19.1
Unspecified viral hepatitis B without hepatic coma

B19.10
Unspecified viral hepatitis B with hepatic coma

B19.11
Unspecified viral hepatitis C

B19.2
Unspecified viral hepatitis C without hepatic coma

B19.20
Unspecified viral hepatitis C with hepatic coma

B19.21
Unspecified viral hepatitis without hepatic coma

B19.9

HIV
042
B20

High-risk homosexual behavior

Z72.52

At risk specifically for hepatitis A
a

Noninjection drug use
Drug dependence
304

Opioid type dependence
304.0

Opioid-related disorders

F11 and F11.X and F11.XX and F11.XXX
Barbiturate and similarly active sedative or hypnotic dependence
304.1

Sedative, hypnotic, or anxiolytic-related disorders

F13 and F13.X and F13.XX and F13.XXX
Cocaine dependence
304.2

Cocaine-related disorders

F14 and F14.X and F14.XX and F14.XXX
Cannabis dependence
304.3

Cannabis-related disorders

F12 and F12.X and F12.XX and F12.XXX
Amphetamine and other psychostimulant dependence
304.4

Other stimulant-related disorders

F15 and F15.X and F15.XX and F15.XXX
Other specified drug dependence
304.6

Combination of opioid type drug with any other
304.7

Combinations of drug dependence excluding opioid type drug
304.8

Unspecified drug dependence
304.9

Nondependent drugs of abuse
305

Cannabis abuse
305.2

Hallucinogen abuse
305.3

Hallucinogen-related disorders

F16 and F16.X and F16.XX and F16.XXX
Barbiturate and similarly acting sedative and hypnotic abuse
305.4

Opioid abuse
305.5

Cocaine abuse
305.6

Amphetamine or-related acting sympathomimetic abuse
305.7

Other, mixed, or unspecified drug abuse
305.9

Inhalant-related disorders

F18 and F18.X and F18.XX and F18.XXX
Other psychoactive substance-related disorders

F19 and F19.X and F19.XX and F19.XXX

Homelessness
V60.0
Z59.0

At risk specifically for hepatitis B b


Sexual exposure risk (includes people seeking evaluation or treatment for a sexually transmitted infection)
Early syphilis, symptomatic
091 and 091.X

Early syphilis, latent
092 or 092.X

Cardiovascular syphilis
093 or 093.X or 093.XX

Neurosyphilis
094 or 094.X or 094.XX

Other forms of late syphilis, with symptoms
095 and 095.X

Late syphilis, latent
096

Other and unspecified syphilis
097 and 097.X

Gonococcal infections
098 and 098.X and 098.XX
A54 and A54.X and A54.XX
Other venereal diseases
099 and 099.X and 099.XX

Genital herpes
054.1

Genital warts
078.11

Unspecified viral and chlamydial infection
079.8

Other specified chlamydial infection
079.88

Unspecified chlamydial infection
079.98

Trichomoniasis
131 and 131.X and 131.XX
A59 and A59.X and A59.XX
Early syphilis

A51 and A51.X
Late syphilis

A52 and A52.X
Other and unspecified syphilis

A53 and A53.X
Chlamydial lymphogranuloma (venereum)

A55
Other sexually transmitted chlamydial diseases

A56 and A56.X and A56.XX
Chancroid

A57
Granuloma inguinale

A58
Anogenital herpesviral [herpes simplex] infections

A60 and A60.X and A60.XX
Other predominantly sexually transmitted diseases, not elsewhere classified

A63 and A63.X
Unspecified sexually transmitted disease

A64
Mycoplasma genitalum

A49.3
Percutaneous or mucosal risk for exposure to blood c
Renal dialysis status
V45.11

Chronic kidney disease stage 4

N18.4
Chronic kidney disease stage 5

N18.5
End-stage renal disease

N18.6
Dependence on renal dialysis (hemodialysis or peritoneal dialysis)

Z99.2
Diabetes mellitus due to underlying condition (for people aged <60 y)

E08 and E08.X and E08.XX and E08.XXX
Drug or chemical induced diabetes mellitus (for people aged <60 y)

E09 and E09.X and E09.XX and E09.XXX
Type 1 diabetes mellitus (for people aged <60 y)

E10 and E10.X and E10.XX and E10.XXX
Type 2 diabetes mellitus (for people aged <60 y)
250 and 250.X
E11 and E11.X and E11.XX and E11.XXX
Other specified diabetes mellitus (for people aged <60 y) E13 and E13.X and E13.XX and E13.XXX Abbreviations: HBsAg, hepatitis B surface antigen; ICD, International Classification of Diseases.
a Risk factors for hepatitis A that could not be sampled for through ICD 9/ICD 10 codes: occupational exposure to virus; intravenous drug use; travel in countries with high or intermediate endemic hepatitis A; close, personal contact with international adoptee; settings for exposure, including   health care settings with services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled people.
b Risk factors for hepatitis B that could not be sampled for through ICD9/ICD 10 codes: intravenous drug use; household contacts of HBsAg-positive people; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; incarcerated people; travel in countries with high or intermediate endemic hepatitis B.
c Includes hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; people with diabetes mellitus aged younger than 60 years, shared clinical decision-making for people aged 60 years or older.

Abbreviations: HBsAg, hepatitis B surface antigen; ICD, International Classification of Diseases.

a Risk factors for hepatitis A that could not be sampled for through ICD 9/ICD 10 codes: occupational exposure to virus; intravenous drug use; travel in countries with high or intermediate endemic hepatitis A; close, personal contact with international adoptee; settings for exposure, including   health care settings with services to injection or noninjection drug users or group homes and nonresidential day care facilities for developmentally disabled people.

b Risk factors for hepatitis B that could not be sampled for through ICD9/ICD 10 codes: intravenous drug use; household contacts of HBsAg-positive people; residents and staff of facilities for developmentally disabled persons; health care and public safety personnel with reasonably anticipated risk for exposure to blood or blood-contaminated body fluids; incarcerated people; travel in countries with high or intermediate endemic hepatitis B.

c Includes hemodialysis, peritoneal dialysis, home dialysis, and predialysis patients; people with diabetes mellitus aged younger than 60 years, shared clinical decision-making for people aged 60 years or older.

Footnotes

The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

Suggested citation for this article: Crane LA, Hurley LP, Daley MF, Beaty B, Rice JD, Homdayjanakul KJ, et al. Accuracy of Surveys for Estimating Coverage for Hepatitis A and B Vaccinations in Adults. Prev Chronic Dis 2026;23:250481. DOI: https://doi.org/10.5888/pcd23.250481 .

References