{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T12:49:34Z","timestamp":1784638174642,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:00Z","timestamp":1628035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K23 AR071500"],"award-info":[{"award-number":["K23 AR071500"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["K24 AR066109"],"award-info":[{"award-number":["K24 AR066109"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Nearly 25% of patients with systemic lupus erythematosus (SLE) are hospitalized yearly, often for outcomes that may have been avoided if patients had received sustained outpatient care. We examined acute care use for vaccine\u2010preventable illnesses to determine sociodemographic contributors and modifiable predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using US Medicaid claims from 29 states (2000\u20132010), we identified adults (18\u201365 years) with prevalent SLE and 12 months of enrollment prior to the first SLE code (index date) to identify baseline data. We defined acute care use for vaccine\u2010preventable illnesses as emergency department (ED) or hospital discharge diagnoses for influenza, pneumococcal disease, meningococcal disease, herpes zoster, high\u2010grade cervical dysplasia\/cervical cancer, and hepatitis B after the index date. We estimated the incidence rate of vaccine\u2010preventable illnesses and used Cox regression to assess risk (with hazard ratios and 95% confidence intervals) by sociodemographic factors and health care utilization, adjusting for vaccinations, comorbidities, and medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 45,654 Medicaid beneficiaries with SLE, &lt;10% had billing claims for vaccinations. There were 1,290 patients with \u22651 ED visit or hospitalization for a vaccine\u2010preventable illness (6.6 per 1,000 person\u2010years); 93% of events occurred in unvaccinated patients. Patients who were Black compared to White had 22% higher risk. Greater outpatient visits were associated with lower risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Medicaid beneficiaries with SLE who are not vaccinated are at risk for potentially avoidable acute care use for vaccine\u2010preventable illnesses. Racial disparities were noted, with a higher risk among Black patients compared to White patients. Greater outpatient use was associated with reduced risk, suggesting that access to ambulatory care may reduce avoidable acute care use.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24628","type":"journal-article","created":{"date-parts":[[2021,5,5]],"date-time":"2021-05-05T01:04:37Z","timestamp":1620176677000},"page":"1236-1242","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Avoidable Acute Care Use for Vaccine\u2010Preventable Illnesses Among Medicaid Beneficiaries With Lupus"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4980-9770","authenticated-orcid":false,"given":"Candace H.","family":"Feldman","sequence":"first","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Xu","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8972-9388","authenticated-orcid":false,"given":"Karen H.","family":"Costenbader","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,8,4]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Healthcare Cost and Utilization Project statistical briefs","author":"Elixhauser A","year":"2013"},{"key":"e_1_2_7_3_1","unstructured":"Department of Health and Human Services Agency for Healthcare Research and Quality.Guide to prevention quality indicators: hospital admission for ambulatory care sensitive conditions. October2001. URL:https:\/\/www.ahrq.gov\/downloads\/pub\/ahrqqi\/pqiguide.pdf."},{"key":"e_1_2_7_4_1","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1002\/acr.24095","article-title":"Development of a set of lupus\u2010specific ambulatory care\u2013sensitive, potentially preventable adverse conditions: a Delphi consensus study","volume":"73","author":"Feldman CH","year":"2021","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"e_1_2_7_5_1","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1002\/art.39070","article-title":"Serious infections among adult Medicaid beneficiaries with systemic lupus erythematosus and lupus nephritis","volume":"67","author":"Feldman CH","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"e0144918","DOI":"10.1371\/journal.pone.0144918","article-title":"National lupus hospitalization trends reveal rising rates of herpes zoster and declines in pneumocystis pneumonia","volume":"11","author":"Murray SG","year":"2016","journal-title":"PLoS One"},{"key":"e_1_2_7_7_1","doi-asserted-by":"crossref","first-page":"e0147856","DOI":"10.1371\/journal.pone.0147856","article-title":"Immunogenicity and safety of influenza vaccination in systemic lupus erythematosus patients compared with healthy controls: a meta\u2010analysis","volume":"11","author":"Liao Z","year":"2016","journal-title":"PLoS One"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"e0117620","DOI":"10.1371\/journal.pone.0117620","article-title":"Human papillomavirus vaccine uptake among individuals with systemic inflammatory diseases","volume":"10","author":"Feldman CH","year":"2015","journal-title":"PLoS One"},{"key":"e_1_2_7_9_1","doi-asserted-by":"crossref","first-page":"R84","DOI":"10.1186\/ar3011","article-title":"Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study","volume":"12","author":"Yazdany J","year":"2010","journal-title":"Arthritis Res Ther"},{"key":"e_1_2_7_10_1","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.3899\/jrheum.171377","article-title":"Improving the combination pneumococcal vaccination rate in systemic lupus erythematosus patients at an adult rheumatology practice","volume":"45","author":"Garg S","year":"2018","journal-title":"J Rheumatol"},{"key":"e_1_2_7_11_1","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1002\/art.37795","article-title":"Epidemiology and sociodemographics of systemic lupus erythematosus and lupus nephritis among US adults with Medicaid coverage, 2000\u20132004","volume":"65","author":"Feldman CH","year":"2013","journal-title":"Arthritis Rheum"},{"key":"e_1_2_7_12_1","first-page":"1408","article-title":"Development and testing of a systemic lupus\u2010specific risk adjustment index for in\u2010hospital mortality","volume":"27","author":"Ward MM","year":"2000","journal-title":"J Rheumatol"},{"key":"e_1_2_7_13_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3899\/jrheum.160179","article-title":"Improvement in herpes zoster vaccination in patients with rheumatoid arthritis: a quality improvement project","volume":"44","author":"Sheth H","year":"2017","journal-title":"J Rheumatol"},{"key":"e_1_2_7_14_1","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1002\/acr.22182","article-title":"Quality of care for incident lupus nephritis among Medicaid beneficiaries in the United States","volume":"66","author":"Yazdany J","year":"2014","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"e_1_2_7_15_1","doi-asserted-by":"crossref","first-page":"e203316","DOI":"10.1001\/jamanetworkopen.2020.3316","article-title":"State policies on access to vaccination services for low\u2010income adults","volume":"3","author":"Granade CJ","year":"2020","journal-title":"JAMA Netw Open"},{"key":"e_1_2_7_16_1","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1002\/acr.23569","article-title":"Does systemic lupus erythematosus care provided in a lupus clinic result in higher quality of care than that provided in a general rheumatology clinic?","volume":"70","author":"Arora S","year":"2018","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"e_1_2_7_17_1","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.semarthrit.2015.01.002","article-title":"Reasons for failure to receive pneumococcal and influenza vaccinations among immunosuppressed patients with systemic lupus erythematosus","volume":"44","author":"Lawson EF","year":"2015","journal-title":"Semin Arthritis Rheum"},{"key":"e_1_2_7_18_1","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.4161\/hv.29303","article-title":"Burden of vaccine\u2010preventable disease in adult Medicaid and commercially insured populations: analysis of claims\u2010based databases, 2006\u20132010","volume":"10","author":"Krishnarajah G","year":"2014","journal-title":"Hum Vaccin Immunother"}],"container-title":["Arthritis Care &amp; 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