Validation of self-report of influenza and pneumococcal vaccination statusin elderly outpatients

Objective: To assess the validity of self-reported influenza and pneumococc al vaccination status. Design: Cross-sectional surveys of outpatients aged 65 years or older. Setting: A Veterans Affairs Medical Center (VA) and a community managed car e organization (MCO). Both organizations have organized influenza and pneum ococcal vaccination programs. Subjects: VA subjects included all elderly respondents to a mailed sun ey o f 500 randomly selected outpatients. MCO subjects included all respondents to a telephone survey of 300 randomly selected elderly members of the MCO. Measurements:The VA survey was conducted following the 1995-1996 influenza season while the MCO survey was conducted following the 1994-1995 season. S elf-report from the mailed sun ey for VA subjects and from the telephone su rvey for MCO subjects was compared to medical record documentation (paper a nd computerized combined). Results: The response rate was 77% (n = 369) for the VA subjects of whom 19 5 (53%) were aged 65 or older. The response rate for the MCO subjects was 8 4% (n = 237). Self-report of influenza vaccination had a sensitivity (SENS) of 1.0 and a specificity (SPEC) of .79 with a kappa of .72 (95% CI .58-.86 ) among VA patients. Among MCO patients, self-report of influenza vaccinati on had a SENS of .98 and a SPEC of .71 with kappa of .75 (95% CI .69-.89). Self-report of pneumococcal vaccination status among VA patients had a SENS of .97 and a SPEC of .53 with a kappa of .42 (95%CI .32-.52). Among MCO pa tients, self-report of pneumococcal vaccination had a SENS of .90 and a SPE C of .61 with a kappa of .54 (95%CI .40-.68). A secondary analysis excludin g subjects living outside of the VA's catchment area improved the specifici ty and indices of concordance of self-report of both influenza and pneumoco ccal vaccination. A secondary: analysis of MCO data which excluded subjects who received a pneumococcal vaccination > 2 years prior to the study also improved concordance and the negative predictive value of self-report. Self -report of influenza vaccination is a highly sensitive and moderately speci fic measure. Conclusion: Self-report of pneumococcal vaccination is also a highly sensit ive but less specific measure of vaccination status. Lower rates of validit y for pneumococcal vaccination may reflect both less accurate recall, parti cularly for more distant vaccination, and less complete documentation in me dical records. (C) 1999 American Journal of Preventive Medicine.