Pneumococcal Vaccination in Nursing Homes: Does Race Make a Difference?

Long-term Care Statistics Branch, Division of Health Care Statistics, National Center Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA.
Journal of the American Medical Directors Association (Impact Factor: 4.94). 11/2008; 9(9):641-7. DOI: 10.1016/j.jamda.2008.03.016
Source: PubMed


Known disparities in pneumococcal vaccination in the community raise the question of whether disparities also exist in the nursing home setting, which is better controlled. This study used nationally representative nursing home data to compare black and white nursing home residents with respect to receiving, not receiving, or having an unknown PPV vaccination status, and to examine the interaction of race with various facility characteristics.
Multinomial logistic regression was used to analyze a 2-year merged file (1997 and 1999) of the National Nursing Home Survey, a cross-sectional national probability sample of nursing homes and residents.
Residents 65 years or older (n = 14,782) residing in nursing homes between July and December of 1997 or 1999.
Record-based staff report of whether residents ever had a pneumococcal immunization (yes/no/unknown); race measured as black or white.
Pneumococcal vaccination rates are lower for black nursing home residents than for white residents, as shown using a merged file of the 1997 and 1999 National Nursing Home Surveys. Participants include 14,303 randomly sampled residents 65 years or older. In this sample, 31% of black residents compared with 24% of white residents 65 years or older had never received pneumococcal vaccination (P < .01). Multivariate logistic regression confirmed that blacks were more likely to be unimmunized than whites (95% CIs), specifically in Medicaid-only facilities and dually certified Medicare and Medicaid facilities. Blacks also had higher odds of unknown vaccination status than whites in Medicaid-only facilities and lower odds of unknown status in government-owned facilities.
Results suggest that the racial difference in pneumococcal vaccination exists predominantly in certain facility types. In addition, facility-based interventions such as having an organized PPV immunization program or improving documentation of vaccination status can be effective in increasing vaccination rates for all races.

1 Follower
10 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: By approaching LTC immunizations systematically and applying the steps reviewed in this article, facilities can improve their immunization rates. While individual barriers such as race or lack of education may play a minor role, organizational barriers are more likely to be important. Focusing effort on these barriers should result in more substantial improvements over time. It is important that we establish immunization programs as regulatory and patient safety priorities in our LTC facilities. Organizations such as AMDA can provide helpful resources to those interested.
    Journal of the American Medical Directors Association 12/2008; 9(9):617-21. DOI:10.1016/j.jamda.2008.08.008 · 4.94 Impact Factor

  • Journal of the American Medical Directors Association 06/2009; 10(4):283. DOI:10.1016/j.jamda.2008.12.054 · 4.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined racial disparities in receipt and documentation of influenza and pneumococcus vaccinations among nursing-home residents. We performed secondary analyses of data from a nationally representative survey of White (n = 11 448) and Black (n = 1174) nursing-home residents in 2004. Bivariate and multivariate analyses determined racial disparities in receipt of influenza vaccination in 2003 and 2004, receipt of pneumococcus vaccination ever, and having a documented history for each vaccination. The overall vaccination rate was 76.2% for influenza and 48.5% for pneumococcus infection. Compared with Whites, Blacks showed a 13% lower vaccination rate and a 5% higher undocumentation rate for influenza, and a 15% lower vaccination rate and a 7% higher undocumentation rate for pneumococcus. For influenza, the odds ratio (OR) for Blacks being unvaccinated was 1.84 (P < or = .001), and the OR for Blacks having undocumented vaccination was 1.85 (P = .001). For pneumococcus infection, the OR for Blacks being unvaccinated was 1.70 (P < or = .001), and the OR for Blacks having undocumented vaccination was 1.95 (P < or = .001). Stratified analyses confirmed persistent racial disparities among subpopulations. Racial disparities exist in vaccination coverage among US nursing-home residents. Targeted interventions to improve vaccination coverage for minority nursing-home residents are warranted.
    American Journal of Public Health 02/2010; 100 Suppl 1(S1):S256-62. DOI:10.2105/AJPH.2009.173468 · 4.55 Impact Factor
Show more