Immunization Disparities in Older Americans. Determinants and Future Research Needs

Center for Studying Health System Change, Washington, DC 20024-2512, USA.
American Journal of Preventive Medicine (Impact Factor: 4.53). 09/2006; 31(2):150-8. DOI: 10.1016/j.amepre.2006.03.021
Source: PubMed


Marked racial disparities persist in influenza and pneumococcal vaccinations among Medicare beneficiaries. This study sought to assess the contribution that patient, physician, health system, and area-level characteristics make to these racial disparities in immunization.
Cross-sectional and decomposition analyses were performed on a nationally representative sample of 18,013 non-institutionalized Medicare beneficiaries who responded to the Medicare Current Beneficiary Survey (MCBS) in 2000 to 2002. The physician characteristics of interest included specialty type, accessibility, information-giving skills, perceived quality, and continuity of care. Health system characteristics included HMO enrollment and numbers of primary care physicians per elderly. The outcomes were receipt of influenza vaccine in the past year and ever having received a pneumococcal vaccine.
Immunization rates were below recommended levels for all Medicare beneficiaries. Disparities between white and black beneficiaries in the receipt of vaccinations were large-an absolute 17% difference for each vaccine. After adjusting for patient, physician, health system, and area-level characteristics, white beneficiaries had significantly higher odds of vaccination than did black beneficiaries: adjusted odds ratio (aOR) = 1.52 (95% confidence interval [CI] = 1.35-1.71) for influenza vaccination, and aOR = 1.82 (95% CI = 1.61-2.07) for pneumococcal vaccination. Beneficiaries with a usual physician that they rated as having good information-giving skills and whose practice was more accessible, had higher immunization rates. Beneficiaries with a primary care generalist as their usual physician had higher odds of immunization than those with a specialist as their usual physician. At the county level, a higher number of primary care physicians per elderly resident was associated with higher odds of immunization. Only 7% of the racial disparity in influenza immunization was explained by the measured characteristics of beneficiaries and their health systems.
Despite similar insurance coverage and presence of a usual physician, black beneficiaries were significantly less likely than their white counterparts to receive influenza and pneumococcal vaccinations. The implications for future research are discussed, including the need for system-based interventions that make the offering and discussion of vaccination routine.

15 Reads
  • Source
    • "Even though previous studies reported a significant association between influenza vaccination and differences in income19-22, having a healthcare provider23,24, marital status19,21,25, last routine checkup22,26,27, general health status27-29 and smoking status26,27, none of these factors were found to have a significant effect on the racial disparity in influenza vaccine coverage in this study. However, these variables might contribute to this disparity by acting as mediators, which we did not account for. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BackgroundPatients with diabetes who contract influenza are at higher risk of complications, such as hospitalization and death. Patients with diabetes are three times more likely to die from influenza complications than those without diabetes. Racial disparities among patients with diabetes in preventive health services have not been extensively studied.ObjectiveTo compare influenza vaccination rates among African Americans and Whites patients with diabetes and investigate factors that might have an impact on racial disparities in the receipt of influenza vaccinations.MethodsA secondary data analysis of 47,283 (unweighted) patients with diabetes from the 2011 Behavioral Risk Factor Surveillance System survey (BRFSS) (15,902,478 weighted) was performed. The survey respondents were asked whether they received an influenza vaccination in the last twelve months. We used logistic regression to estimate the odds of receiving the influenza vaccine based on race.ResultsThe results indicated a significantly lower proportion of African Americans respondents (50%) reported receiving the influenza vaccination in the last year when compared with Whites respondents (61%). Age, gender, education, health care coverage, health care cost, and employment status were found to significantly modify the effect of race on receiving the influenza vaccination.ConclusionsThis study found a significant racial disparity in influenza vaccination rates in adults with diabetes with higher rates in Whites compared to African Americans individuals. The public health policies that target diabetes patients in general and specifically African Americans in the 65+ age group, women, and homemakers, may be necessary to diminish the racial disparity in influenza vaccination rates between African Americans and Whites diabetics.
    Pharmacy Practice 04/2014; 12(2):410. DOI:10.4321/S1886-36552014000200008
  • Source
    • "In the US, four or more outpatient visits during the year previous to the survey increased the likelihood of influenza vaccination (AOR 1.6, 95% CI 1.5-1.8) [27]. Similarly, Spanish women with at least one physician visit in the last two years had significantly higher probabilities of being vaccinated (AOR 4.8, 95% CI 2.6-8.9) "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Vaccination against influenza is considered the most important public health intervention to prevent unnecessary hospitalizations and premature deaths related to influenza in the elderly, though there are significant inequities among global influenza vaccine resources, capacities, and policies. The objective of this study was to assess the social determinants of health preventing adults ≥65 years old from accessing and accepting seasonal influenza vaccination. Methods A systematic search was performed in January 2011 using MEDLINE, ISI – Web of Science, PsycINFO, and CINAHL (1980–2011). Reference lists of articles were also examined. Selection criteria included qualitative and quantitative studies written in English that examined social determinants of and barriers against seasonal influenza vaccination among adults≥65 years. Two authors performed the quality assessment and data extraction. Thematic analysis was the main approach for joint synthesis, using identification and juxtaposition of themes associated with vaccination. Results Overall, 58 studies were analyzed. Structural social determinants such as age, gender, marital status, education, ethnicity, socio-economic status, social and cultural values, as well as intermediary determinants including housing-place of residence, behavioral beliefs, social influences, previous vaccine experiences, perceived susceptibility, sources of information, and perceived health status influenced seasonal influenza vaccination. Healthcare system related factors including accessibility, affordability, knowledge and attitudes about vaccination, and physicians’ advice were also important determinants of vaccination. Conclusions Our results demonstrate that the ability of adults ≥65 years to receive seasonal influenza vaccine is influenced by structural, intermediate, and healthcare-related social determinants which have an impact at the health system, provider, and individual levels.
    BMC Public Health 04/2013; 13(1):388. DOI:10.1186/1471-2458-13-388 · 2.26 Impact Factor
  • Source
    • "The adoption of plans and interventions that address the differential demographic impact of influenza may help to partially prevent the consequence of social inequalities on disease outcomes [1,11]. However, awareness of the risk of the “inverse care law” [43], that is, increased inequality due to the higher social classes having better access to preventive interventions should also be heightened. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background During the 2009 influenza pandemic, a change in the type of patients most often affected by influenza was observed. The objective of this study was to assess the role of individual and social determinants in hospitalizations due to influenza A (H1N1) 2009 infection. Methods We studied hospitalized patients (cases) and outpatients (controls) with confirmed influenza A (H1N1) 2009 infection. A standardized questionnaire was used to collect data. Variables that might be related to the hospitalization of influenza cases were compared by estimation of the odds ratio (OR) and 95% confidence intervals (CI) and the variables entered into binomial logistic regression models. Results Hospitalization due to pandemic A (H1N1) 2009 influenza virus infections was associated with non-Caucasian ethnicity (OR: 2.18, 95% CI 1.17 − 4.08), overcrowding (OR: 2.84, 95% CI 1.20 − 6.72), comorbidity and the lack of previous preventive information (OR: 2.69, 95% CI: 1.50 − 4.83). Secondary or higher education was associated with a lower risk of hospitalization (OR 0.56, 95% CI: 0.36 − 0.87) Conclusions In addition to individual factors such as comorbidity, other factors such as educational level, ethnicity or overcrowding were associated with hospitalization due to A (H1N1) 2009 influenza virus infections.
    BMC Public Health 02/2013; 13(1):118. DOI:10.1186/1471-2458-13-118 · 2.26 Impact Factor
Show more