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Kasting ML, Laily A, Burney HN, Head KJ, Daggy JK, Zimet GD, Schwab-Reese LM. County-Level Factors Associated With Influenza and COVID-19 Vaccination in Indiana, 2020‒2022. Am J Public Health 2024; 114:415-423. [PMID: 38386970 PMCID: PMC10937598 DOI: 10.2105/ajph.2023.307553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/24/2024]
Abstract
Objectives. To assess COVID-19 and influenza vaccination rates across Indiana's 92 counties and identify county-level factors associated with vaccination. Methods. We analyzed county-level data on adult COVID-19 vaccination from the Indiana vaccine registry and 2021 adult influenza vaccination from the Centers for Disease Control and Prevention. We used multiple linear regression (MLR) to determine county-level predictors of vaccinations. Results. COVID-19 vaccination ranged from 31.2% to 87.6% (mean = 58.0%); influenza vaccination ranged from 33.7% to 53.1% (mean = 42.9%). In MLR, COVID-19 vaccination was significantly associated with primary care providers per capita (b = 0.04; 95% confidence interval [CI] = 0.02, 0.05), median household income (b = 0.23; 95% CI = 0.12, 0.34), percentage Medicare enrollees with a mammogram (b = 0.29; 95% CI = 0.08, 0.51), percentage uninsured (b = -1.22; 95% CI = -1.57, -0.87), percentage African American (b = 0.31; 95% CI = 0.19, 0.42), percentage female (b = -0.97; 95% CI = -1.79, ‒0.15), and percentage who smoke (b = -0.75; 95% CI = -1.26, -0.23). Influenza vaccination was significantly associated with percentage uninsured (b = 0.71; 95% CI = 0.22, 1.21), percentage African American (b = -0.07; 95% CI = -0.13, -0.01), percentage Hispanic (b = -0.28; 95% CI = -0.40, -0.17), percentage who smoke (b = -0.85; 95% CI = -1.06, -0.64), and percentage who completed high school (b = 0.54; 95% CI = 0.21, 0.87). The MLR models explained 86.7% (COVID-19) and 70.2% (influenza) of the variance. Conclusions. Factors associated with COVID-19 and influenza vaccinations varied. Variables reflecting access to care (e.g., insurance) and higher risk of severe disease (e.g., smoking) are notable. Programs to improve access and target high-risk populations may improve vaccination rates. (Am J Public Health. 2024;114(4):415-423. https://doi.org/10.2105/AJPH.2023.307553).
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Affiliation(s)
- Monica L Kasting
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Alfu Laily
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Heather N Burney
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Katharine J Head
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Joanne K Daggy
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Gregory D Zimet
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
| | - Laura M Schwab-Reese
- Monica L. Kasting, Alfu Laily, and Laura M. Schwab-Reese are with the Department of Public Health at Purdue University, West Lafayette, IN. Heather N. Burney and Joanne K. Daggy are with the Department of Biostatistics and Health Data Science at the Indiana University School of Medicine, Indianapolis. Katharine J. Head is with the Department of Communication Studies at Indiana University‒Purdue University, Indianapolis. Gregory D. Zimet is professor emeritus of Pediatrics and Psychiatry at the Indiana University School of Medicine, Indianapolis
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Delays and declines in seasonal influenza vaccinations due to Hurricane Harvey narrow annual gaps in vaccination by race, income and rurality. Infect Control Hosp Epidemiol 2022; 43:1833-1839. [PMID: 35292125 PMCID: PMC9753087 DOI: 10.1017/ice.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Temporal overlap of the Atlantic hurricane season and seasonal influenza vaccine rollout has the potential to result in delays or disruptions of vaccination campaigns. We documented seasonal influenza vaccination behavior over a 5-year period and explored associations between flooding following Hurricane Harvey and timing and uptake of vaccines, as well as how the impacts of Hurricane Harvey on vaccination vary by race, wealth, and rurality. DESIGN Retrospective cohort analysis. SETTING Texas counties affected by Hurricane Harvey. PATIENTS Active users of the Veterans' Health Administration in 2017. METHODS We used geocoded residential address data to assess flood exposure status following Hurricane Harvey. Days to receipt of seasonal influenza vaccines were calculated for each year from 2014 to 2019. Proportional hazards models were used to determine how likelihood of vaccination varied according to flood status as well as the race, wealth, and rural-urban residence of patients. RESULTS The year of Hurricane Harvey was associated with a median delay of 2 weeks to vaccination and lower overall vaccination than in prior years. Residential status in flooded areas was associated with lower hazards of influenza vaccination in all years. White patients had higher proportional hazards of influenza vaccination than non-White patients, though this attenuated to 6.39% (hazard ratio [HR], 1.0639; 95% confidence interval [CI], 1.034-1.095) in the hurricane. year. CONCLUSIONS Receipt of seasonal influenza vaccination following regional exposure to the effects of Hurricane Harvey was delayed among US veterans. White, non-low-income, and rural patients had higher likelihood of vaccination in all years of the study, but these gaps narrowed during the hurricane year.
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Khorasani S, Zubiago J, Carreiro J, Guardado R, Wurcel AG. Influenza Vaccination in Massachusetts Jails: A Mixed-Methods Analysis. Public Health Rep 2022; 137:936-943. [PMID: 34524903 PMCID: PMC9379841 DOI: 10.1177/00333549211041659] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Influenza infects millions of people each year and contributes to tens of thousands of deaths annually despite the availability of vaccines. People most at risk of influenza complications are disproportionately represented in people incarcerated in US prisons and jails. The objectives of this study were to survey health administrators in Massachusetts county jails about institutional influenza vaccine policies and practices and estimate influenza vaccination rates in Massachusetts jails from 2013 to 2020. METHODS In April 2020, we administered surveys to the health services administrators in Massachusetts' 14 county jails to gather information about influenza vaccination policies and delivery practices. To calculate influenza vaccination rates for each facility, we obtained data on influenza vaccine orders from the Massachusetts Department of Public Health for each county in Massachusetts for influenza seasons 2013-2020. We calculated summary statistics for each reporting facility and each year, conducted a Kruskal-Wallis analysis to compare vaccination rates between years, and used a linear regression model to identify predictors of vaccination rates. RESULTS Influenza vaccination rates in Massachusetts jails ranged from 1.9% to 11.8%. We found no significant differences in vaccination rates between years. Influenza vaccine ordering and delivery practices varied by jail, and respondents had high levels of confidence in influenza policies and vaccine delivery practices. CONCLUSIONS Influenza vaccination rates in Massachusetts jails are low, and delivery practices in jails vary. Lack of influenza vaccinations in jails is a gap in health care that needs to be prioritized, especially considering the current COVID-19 pandemic. Further investigations for effective and equitable vaccination in this population should involve people who are incarcerated and people who make influenza vaccine policies in jails.
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Affiliation(s)
| | - Julia Zubiago
- Division of Geographic Medicine and Infectious Diseases,
Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Jac Carreiro
- Tufts University School of Medicine, Boston, MA, USA
| | - Rubeen Guardado
- Division of Geographic Medicine and Infectious Diseases,
Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Alysse G. Wurcel
- Tufts University School of Medicine, Boston, MA, USA
- Division of Geographic Medicine and Infectious Diseases,
Department of Medicine, Tufts Medical Center, Boston, MA, USA
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Enogela EM, Buchanan T, Carter CS, Elk R, Gazaway SB, Goodin BR, Jackson EA, Jones R, Kennedy RE, Perez-Costas E, Zubkoff L, Zumbro EL, Markland AD, Buford TW. Preserving independence among under-resourced older adults in the Southeastern United States: existing barriers and potential strategies for research. Int J Equity Health 2022; 21:119. [PMID: 36030252 PMCID: PMC9419141 DOI: 10.1186/s12939-022-01721-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Disability prevention and preservation of independence is crucial for successful aging of older adults. To date, relatively little is known regarding disparities in independent aging in a disadvantaged older adult population despite widely recognized health disparities reported in other populations and disciplines. In the U.S., the Southeastern region also known as “the Deep South”, is an economically and culturally unique region ravaged by pervasive health disparities – thus it is critical to evaluate barriers to independent aging in this region along with strategies to overcome these barriers. The objective of this narrative review is to highlight unique barriers to independent aging in the Deep South and to acknowledge gaps and potential strategies and opportunities to fill these gaps. We have synthesized findings of literature retrieved from searches of computerized databases and authoritative texts. Ultimately, this review aims to facilitate discussion and future research that will help to address the unique challenges to the preservation of independence among older adults in the Deep South region.
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Affiliation(s)
- Ene M Enogela
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Taylor Buchanan
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Christy S Carter
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Ronit Elk
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Shena B Gazaway
- Department of Family, Community, and Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Department of Medicine - Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raymond Jones
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Richard E Kennedy
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Emma Perez-Costas
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Lisa Zubkoff
- Department of Medicine - Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Emily L Zumbro
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA
| | - Alayne D Markland
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA
| | - Thomas W Buford
- Department of Medicine - Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, 1313 13thSt. South, Birmingham, AL, 35205, USA. .,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, AL, USA.
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Al Rifai M, Jain V, Khan SU, Nasir K, Zhu D, Vasudeva R, Lavie CJ, Dodani S, Petersen LA, Virani SS. Social vulnerability and COVID-19: An analysis of CDC data. Prog Cardiovasc Dis 2022; 73:91-93. [PMID: 34560121 PMCID: PMC8455239 DOI: 10.1016/j.pcad.2021.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Vardhmaan Jain
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Khurram Nasir
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Dongshan Zhu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China; NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan 250012, China
| | - Rhythm Vasudeva
- Department of Medicine and Pediatrics, University of Kansas School of Medicine- Wichita, Kansas, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, New Orleans, LA, USA
| | - Sunita Dodani
- Section of Cardiology, Department of Internal Medicine, Eastern Virginia Medical School (EVMS), Norfolk, VA, USA; EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Norfolk, VA, USA
| | - Laura A Petersen
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services, Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA; Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services, Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Li K, Yu T, Seabury SA, Dor A. Trends and Disparities in the Utilization of Influenza Vaccines Among Commercially Insured US Adults During the COVID-19 Pandemic. Vaccine 2022; 40:2696-2704. [PMID: 35370018 PMCID: PMC8960160 DOI: 10.1016/j.vaccine.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
Objectives Little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected influenza vaccine utilization and disparities. We sought to estimate changes in the likelihood of receiving an influenza vaccine across different demographic subgroups during the COVID-19 pandemic. Methods In this cohort study, we analyzed influenza vaccine uptake from 2019 to 2020 using Optum commercial insurance claims data. Eligible individuals were aged 18 or above in 2018 and continuously enrolled from 08/01/2018 through 12/31/2020. Multivariable logistic regressions were fitted for the individual-level influenza vaccine uptake. Adjusting for demographic factors and medical histories, we estimated probabilities of receiving influenza vaccines before and after the COVID-19 pandemic across demographic subgroups. Results From August to December 2019, unadjusted influenza vaccination rate was 42.3%, while in the same period of 2020, the vaccination rate increased to 45.9%. Females had a higher vaccination rate in 2019 (OR: 1.16, 95% CI 1.15–1.16), but the increase was larger for males. Blacks and Hispanics had lower vaccination rates relative to whites in both flu seasons. Hispanics showed a greater increase in vaccination rate, increasing by 7.8 percentage points (p < .001) compared to 4.4 (p < .001) for whites. The vaccination rate for Blacks increased by 5.2 percentage points (p < .001). All income groups experienced vaccination improvements, but poorer individuals had lower vaccination rates in both seasons. The most profound disparities occurred when educational cohort were considered. The vaccination rate increased among college-educated enrollees by 8.8 percentage points (p < .001) during the pandemic compared to an increase of 2.8 percentage points (p < .001) for enrollees with less than a 12th grade education. Past influenza infections or vaccination increased the likelihood of vaccination (p < .001). Conclusions The COVID-19 pandemic was associated with increased influenza vaccine utilization. Disparities persisted but narrowed with respect to gender and race but worsened with respect to income and educational attainment.
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Heintzman J, Hwang J, Quiñones AR, Guzman CEV, Bailey SR, Lucas J, Giebultowicz S, Chan B, Marino M. Influenza and pneumococcal vaccination delivery in older Hispanic populations in the United States. J Am Geriatr Soc 2022; 70:854-861. [PMID: 34854478 PMCID: PMC9904430 DOI: 10.1111/jgs.17589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/29/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION National reports suggest that Hispanic patients may underutilize influenza and pneumococcal vaccination, although studies sometimes conflict on this point. A clearer picture of adult immunization utilization in older Hispanic patients is necessary to ensure equity in adult vaccinations. METHODS Using electronic health records from 648 community health centers (CHCs) across 21 states, we compared English-preferring Hispanic patients, Spanish-preferring Hispanic patients, and Non-Hispanic White (NHW) adults aged ≥50 years across five outcomes between 2012-2017: (1) Odds of ever receiving pneumococcal vaccination after age 65, (2) Odds of ever receiving ≥2 pneumococcal vaccinations for those ≥65, (3) odds of vaccination between the ages of 50 and 64 for those with diabetes or heart disease, (4) odds of influenza vaccine, and (5) annual rate of influenza vaccination. RESULTS Of our total study sample (N = 143,869), 85,562 were age 50-64 during the entire study period, and 65,977 were ≥65 at some point during the study period. In patients aged 50-64, Spanish-preferring Hispanic patients were more likely to have ever had an influenza vaccination (covariate-adjusted odds ratio [aOR] = 1.33, 95% CI = 1.29-1.37), had higher rates of annual influenza vaccination (covariate-adjusted rate ratio [aRR] = 1.41, 95% CI = 1.38-1.44), and higher odds of pneumococcal vaccination (aOR = 1.87, 95% CI = 1.76-1.98) than NHW patients. These findings were similar in Spanish-preferring Hispanic patients ≥65. English-preferring Hispanics ≥65 were less likely than NHW patients to ever have an influenza vaccination (aOR = 0.91, 95% CI = 0.85-0.98) and to have ever received at least one (aOR = 0.92, 95% CI = 0.86-0.99) or two (aOR = 0.86, 95% CI = 0.77-0.95) pneumococcal vaccine doses. CONCLUSIONS In a multistate CHC network, Spanish-preferring Hispanic patients were more likely to receive influenza and pneumococcal vaccinations than NHW patients; older English-preferring Hispanic patients were often less likely than NHW patients to receive these vaccinations. In vaccine initiatives, English-preferring Hispanic patients may be at higher risk of vaccination inequity.
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Affiliation(s)
- John Heintzman
- Associate Professor, Department of Family Medicine, Oregon Health and Science University (OHSU), 3381 Sw Sam Jackson Park Road, Portland, OR 97239
| | - Jun Hwang
- Oregon Health & Science University, Department of Family Medicine, Portland OR
| | - Ana R. Quiñones
- Oregon Health & Science University, Department of Family Medicine, Portland OR
| | | | - Steffani R Bailey
- Oregon Health & Science University, Department of Family Medicine, Portland OR
| | - Jennifer Lucas
- Oregon Health & Science University, Department of Family Medicine, Portland OR
| | | | - Brian Chan
- Oregon Health & Science University, Department of General Internal Medicine
| | - Miguel Marino
- Oregon Health & Science University, Department of Family Medicine, Portland OR
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County Social Vulnerability and Influenza Vaccine Rates: National and Local Estimates for Medicare Recipients. Am J Prev Med 2022; 62:e1-e9. [PMID: 34548222 DOI: 10.1016/j.amepre.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Seasonal influenza vaccination among older adults is well below the recommendation of Healthy People 2020. Although geographic disparities in influenza vaccination are well documented, it remains unclear how community attributes correlate with influenza vaccination rates. Social vulnerability measures play an important role in interventions addressing vaccine equity; however, social vulnerability dimensions as corollaries of vaccination are poorly understood. To inform vaccine equity interventions, this analysis investigates spatially varying associations between county social vulnerability and influenza vaccination rate among Medicare recipients. METHODS County-level 2018 data (N=3,105) from the Centers for Disease Control and Prevention's Social Vulnerability Index were merged with the percentage of Medicare recipients vaccinated against influenza. Multilevel linear regression and geographically weighted regression generated global and local estimates, adjusted for potential confounders. Analyses were conducted in November 2020-April 2021. RESULTS A 10-percentile point increase in the overall Social Vulnerability Index was associated with an 0.87-point decrease in percentage vaccinated (p<0.001) with substantial variation by Social Vulnerability Index theme and geography. A 10-percentile point increase in socioeconomic vulnerability was associated with a 1.6-point decrease in vaccination (p<0.001) with stronger associations in higher Social Vulnerability Index quartiles and in parts of the Midwest, South, and coastal Northeast. Other Social Vulnerability Index themes had smaller associations with mixed directions: household composition and disability estimates were negative, whereas estimates for minority status and language and housing and transportation were positive. CONCLUSIONS Medicare recipients in socioeconomically vulnerable counties have low influenza vaccination rates, particularly in select regions of the country. Best practices to improve vaccine access and uptake should be targeted and should explicitly consider local socioeconomic vulnerability.
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Cho BH, Weinbaum C, Tsai Y, Koppaka R. Influenza Vaccine Uptake and Missed Opportunities Among the Medicare-Covered Population With High-Risk Conditions During the 2018 to 2019 Influenza Season : A Retrospective Cohort Study. Ann Intern Med 2022; 175:1-10. [PMID: 34781717 PMCID: PMC9109634 DOI: 10.7326/m21-1550] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Seasonal influenza causes substantial morbidity and mortality among older U.S. adults and those with comorbid health conditions. OBJECTIVE To describe seasonal influenza vaccine uptake and identify factors associated with missed opportunities for influenza vaccination. DESIGN Retrospective cohort study. SETTING Medicare fee-for-service claims. PARTICIPANTS 31.6 million U.S. adults continuously enrolled under Medicare Parts A and B during the 2018 to 2019 influenza season. MEASUREMENTS Influenza vaccine uptake and missed opportunities by patient demographic characteristics, high-risk status (that is, ≥1 condition increasing influenza complication risk), Medicare-Medicaid dual-eligibility status, and health care provider visits (that is, vaccination opportunities). RESULTS Overall, 50.5% of beneficiaries aged 19 years or older had Medicare claims for influenza vaccination: 31.6% among people aged 19 to 64 years and 54% among people aged 65 years or older. More White beneficiaries were vaccinated (52.9%) than Black (34.9%) or Hispanic (30.4%) beneficiaries. Uptake was higher (56.1%) for beneficiaries with high-risk conditions than for those without (27.6%). Among unvaccinated beneficiaries overall, 77.4% visited a provider during influenza season; among unvaccinated beneficiaries with and without high-risk conditions, 91% and 43%, respectively, had seen a provider at least once. The proportion of beneficiaries with missed opportunities for influenza vaccination was 44.2% and was higher for beneficiaries in the non-high-risk group (59.1%) than those in the high-risk group (42.2%). Uptake was lower and proportions of missed opportunities were higher among beneficiaries in younger age groups, of Black and Hispanic race/ethnicity, without high-risk conditions, or with Medicare-Medicaid dual eligibility. LIMITATIONS Influenza vaccinations without claims could not be captured. Data on reasons for nonvaccination were unavailable. CONCLUSION Influenza vaccination coverage for Medicare beneficiaries continues to be suboptimal, with missed opportunities despite availability of influenza vaccination with no copayment. Disparities persist in vaccination uptake by race/ethnicity. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Bo-Hyun Cho
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (B.C., C.W., Y.T., R.K.)
| | - Cindy Weinbaum
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (B.C., C.W., Y.T., R.K.)
| | - Yuping Tsai
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (B.C., C.W., Y.T., R.K.)
| | - Ram Koppaka
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (B.C., C.W., Y.T., R.K.)
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Sanders-Jackson A, Gonzalez M, Adams RB, Rhodes N. Social determinants of flu vaccine uptake among racial/ethnic minorities in the United States. Prev Med Rep 2021; 24:101516. [PMID: 34976601 PMCID: PMC8683944 DOI: 10.1016/j.pmedr.2021.101516] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 12/25/2022] Open
Abstract
Research on the social determinants of vaccine uptake often occur between racial/ethnic groups and not within groups. Though minoritized individuals face inequalities across the board, these are also not evenly distributed amongst minoritized individuals within groups. Using the National Health Interview Survey data, we examined disparities in flu vaccine uptake across racial/ethnic groups in the United States (US). We examined (a) NH (non-Hispanic) White (n = 32,655), (b) NH Asian (n = 2335), (c) NH African American (n = 5137), and (d) Hispanic (n = 5718) respondents who lived in the United States using the combined 2017 and 2018. We used multivariable logistic regression to predict flu vaccination (yes/no) both in models comparing racial/ethnic groups and within groups. Less than 50% of any of the four major racial/ethnic groups in the US received a flu vaccination in 2017–18. Flu vaccine uptake varied within racial and ethnic groups. These results suggest that increasing vaccination may require a complex, multi-faceted perspective that considers subgroups more directly.
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Affiliation(s)
- Ashley Sanders-Jackson
- Dept. of Advertising and Public Relations, Michigan State University, 404 Wilson Road, East Lansing, MI 48823, USA
| | - Mariaelena Gonzalez
- Department of Public Health, University of California, Merced, 5200 Lake Road, Merced, CA 95343, USA.,Health Science Research Institute, University of California, Merced, 5200 Lake Road, Merced, CA 95343, USA
| | - Robyn B Adams
- Dept. of Advertising and Public Relations, Michigan State University, 404 Wilson Road, East Lansing, MI 48823, USA
| | - Nancy Rhodes
- Dept. of Advertising and Public Relations, Michigan State University, 404 Wilson Road, East Lansing, MI 48823, USA
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11
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Venkatram S, Alapati A, Dileep A, Diaz-Fuentes G. Change in patterns of hospitalization for influenza during COVID-19 surges. Influenza Other Respir Viruses 2021; 16:72-78. [PMID: 34427056 PMCID: PMC8653106 DOI: 10.1111/irv.12900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022] Open
Abstract
Background Hospitalization due to influenza has been stable in recent years. In March 2020, New York was an epicenter for coronavirus disease 2019 (COVID‐19). Because influenza and COVID‐19 present similarly, there were serious concerns that coinfection of these viruses would burden the healthcare system. We compared incidence and outcomes of patients hospitalized with influenza before and during COVID‐19 (seasons 2017–2021). Methods We conducted a retrospective study evaluating hospitalized patients with influenza. Four influenza seasons were evaluated, 2017–2021, pre‐ and during COVID‐19 pandemic. We compared incidence of influenza and clinical outcomes across the seasons. Results We found 412 patients hospitalized due to influenza in the study period; 394 had influenza, and 18 had both influenza and COVID‐19 infections. Demographics across the four influenza seasons were comparable; the cohort was predominantly female (61%) and had an average age of 60 years old. Comorbid conditions were common. No outcome differences were found for patients with influenza when comparing influenza seasons prior to and during the COVID‐19 pandemic. The mortality for the entire cohort was 6.5%. During the COVID‐19 pandemic, there were 18 (4.4%) influenza patients coinfected with COVID‐19 and 32 (7.8%) patients with bacterial super infection. Predictors of mortality in patients with influenza included presence of shock, heart failure, bacterial pneumonia, and use of mechanical ventilation. Coinfection with COVID‐19 did not increase mortality. Conclusion We observed a significant decrease in the incidence of hospitalization due to influenza during the COVID‐19 pandemic. Clinical presentations and outcomes for patients with influenza remain stable. Being aware of possible increased mortality for patients with both influenza and bacterial pneumonia is important. Although coinfection with COVID‐19 did not increase mortality in influenza patients, identifying the specific virus responsible for infections has major therapeutic implications.
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Affiliation(s)
- Sindhaghatta Venkatram
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anuhya Alapati
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arundhati Dileep
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gilda Diaz-Fuentes
- Division of Pulmonary and Critical Care Medicine, BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Callahan AG, Coleman-Cowger VH, Schulkin J, Power ML. Racial disparities in influenza immunization during pregnancy in the United States: A narrative review of the evidence for disparities and potential interventions. Vaccine 2021; 39:4938-4948. [PMID: 34312009 DOI: 10.1016/j.vaccine.2021.07.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The objectives of this review were to summarize existing data on racial disparities in maternal immunization for influenza in the U.S. and to review the literature on interventions to improve the uptake of the influenza vaccine among Black pregnant women. DATA SOURCES U.S. survey data on maternal influenza immunization by racial and ethnic group were summarized in narrative form. To review intervention studies, PubMed, CINAHL, EMBASE, and the Cochrane Library databases were searched for English language articles published 2017 to 2021, in addition to studies identified by a previous systematic review. STUDY ELIGIBILITY CRITERIA Peer-reviewed studies conducted in the U.S. and reporting interventions designed to increase the uptake of the influenza vaccine in pregnancy with study populations including at least 20% of participants identifying as Black were included. STUDY APPRAISAL AND SYNTHESIS METHODS Studies were grouped and reviewed in a narrative manner according to whether they were conducted in predominantly Black populations or in more racially diverse populations, and whether they tested multicomponent or single-component interventions. RESULTS A decade of survey data show that Black women in the U.S. consistently have the lowest rate of influenza immunization in pregnancy. Black women report a lower rate of being recommended or offered the vaccine, and provider recommendation is associated with greater vaccine uptake. Intervention studies to increase influenza immunization among Black pregnant women have reported mixed results. Successful interventions include multicomponent practice-based interventions, group prenatal care, and culturally competent patient educational messages. CONCLUSIONS Racial disparities in maternal uptake of the influenza vaccine are long-standing, but not intractable. More research is needed to test interventions to address this disparity, with a focus on increasing provider recommendation and offer of the vaccine, addressing patients' concerns about vaccine safety and efficacy, improving providers' cultural competence, and building trust between providers and patients.
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Affiliation(s)
- Alice G Callahan
- Health Professions Division, Lane Community College, 4000 East 30th Ave., Eugene, OR 97405, USA.
| | | | - Jay Schulkin
- Department of Obstetrics and Gynecology, University of Washington, 1959 NE Pacific Street, Box 356460, Seattle, WA 98195, USA.
| | - Michael L Power
- Center for Species Survival, Smithsonian National Zoological Park & Conservation Biology Institute, P.O. Box 37012, MRC 5503, Washington, DC 20013-7012, USA.
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13
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Arvanitis M, Opsasnick L, O'Conor R, Curtis LM, Vuyyuru C, Yoshino Benavente J, Bailey SC, Jean-Jacques M, Wolf MS. Factors associated with COVID-19 vaccine trust and hesitancy among adults with chronic conditions. Prev Med Rep 2021; 24:101484. [PMID: 34306998 PMCID: PMC8280610 DOI: 10.1016/j.pmedr.2021.101484] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 11/16/2022] Open
Abstract
In a survey of older adults at higher risk for COVID-19 complications, we sought to describe expectations of trust in the safety and efficacy of a future COVID-19 vaccine, and level of hesitancy about receiving it. We also assessed whether these expectations were associated with known or suspected contributors to vaccine hesitancy, disparities in vaccine receipt, and potential targets for public health outreach. From May 1–22, 2020, we performed telephone surveys of 601 older adults with chronic conditions in metro Chicago about their COVID-19 experiences and levels of vaccine trust and hesitancy. All participants previously completed assessments of demographics, health status, health literacy and activation. Bivariate associations were performed using t-tests or one-way ANOVA, and multivariate analyses using least square means. Younger age (<60), Black race, greater complacency about contracting COVID-19, and lower confidence in state or local government were associated with significantly lower trust in a vaccine’s safety and efficacy. Black race and greater complacency about contracting COVID-19 were associated with a significantly greater vaccine hesitancy. Amongst Black participants, vaccine hesitancy varied significantly by confidence in the federal government. Trust and hesitancy regarding a future COVID-19 vaccine were associated with age, race, complacency regarding contracting COVID-19, and confidence in government response to the pandemic, but not education, health literacy or activation. Therefore, efforts to vaccinate higher risk older adults must aim not only to educate and provide vaccine access, but engender trust in the vaccine development process and vaccination strategies at both the federal and the local level.
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Affiliation(s)
- Marina Arvanitis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lauren Opsasnick
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Laura M Curtis
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Chandana Vuyyuru
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julia Yoshino Benavente
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stacy C Bailey
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Muriel Jean-Jacques
- Division of General Internal Medicine & Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael S Wolf
- Center for Applied Health Research on Aging, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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14
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Dorman C, Perera A, Condon C, Chau C, Qian J, Kalk K, DiazDeleon D. Factors Associated with Willingness to be Vaccinated Against COVID-19 in a Large Convenience Sample. J Community Health 2021; 46:1013-1019. [PMID: 33835369 PMCID: PMC8033546 DOI: 10.1007/s10900-021-00987-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 12/02/2022]
Abstract
Willingness and reasons to be vaccinated against COVID-19 were examined among 26,324 respondents who completed a survey on willingness and questions related to Confidence in vaccine safety, Complacency about the disease, Convenience of vaccination, tendency to Calculate risks versus benefits, and Concern for protecting others. Willingness to be vaccinated differed by age (p < 0.001), by race and ethnicity (p < 0.001) and by level of education (p < 0.001). Willingness generally increased with age and education. Asians were most willing to be vaccinated, followed by non-Hispanic Whites, Hispanics, and non-Hispanic Blacks (p < 0.001). Occupational groups differed in willingness (p < 0.001). Retired and students were more willing than all others (p < 0.001) followed by disabled or unemployed, healthcare workers, and educators. First Responders were least willing to be vaccinated (p < 0.001) followed by construction, maintenance and landscaping, homemakers, housekeeping, cleaning and janitorial workers, and retail and food service. The strongest predictor of willingness was confidence with the safety of the vaccine (r = 0.723, p < 0.001), followed by concern with protecting others by being vaccinated (r = 0.574, p < 0.001), and believing COVID-19 was serious enough to merit vaccination (r = 0.478, p < 0.00). Using multiple regression, confidence in safety was the strongest predictor for all groups. Protecting others was strongest for 13 of 15 demographic groups and 8 of 11 occupational groups. College educated, non-Hispanic Whites, first responders, construction, maintenance and landscape workers, housekeeping, cleaning and janitorial workers all gave greater weight to complacency about the disease. These results can help in designing programs to combat vaccine hesitancy.
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Affiliation(s)
- Casey Dorman
- Orange County Health Care Agency, Santa Ana, CA, 92660, USA.
| | - Anthony Perera
- Orange County Health Care Agency, Santa Ana, CA, 92660, USA
| | - Curt Condon
- Orange County Health Care Agency, Santa Ana, CA, 92660, USA
| | - Clayton Chau
- Orange County Health Care Agency, Santa Ana, CA, 92660, USA
| | - Jenny Qian
- Orange County Health Care Agency, Santa Ana, CA, 92660, USA
| | - Karin Kalk
- Orange County Health Care Agency, Santa Ana, CA, 92660, USA
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15
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Sturm L, Kasting ML, Head KJ, Hartsock JA, Zimet GD. Influenza vaccination in the time of COVID-19: A national U.S. survey of adults. Vaccine 2021; 39:1921-1928. [PMID: 33715898 PMCID: PMC7931729 DOI: 10.1016/j.vaccine.2021.03.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Decisions about influenza vaccination for fall-winter 2020 were made against the backdrop of the COVID-19 pandemic. During May 2020, the authors examined intended vaccination in the next 12 months in relationship to demographic variables, healthcare attitudes, and personal COVID-19 experiences for two samples of adults--those who did not receive influenza vaccine during the prior 12 months, and those who did. METHODS In May 2020, a cross-sectional online survey was conducted with a national US sample. Participants reported prior influenza vaccination (yes/no during prior 12 months) and anticipated vaccination (yes/no during next 12 months). Covariates included demographic characteristics (e.g., gender, race-ethnicity, political ideology), general beliefs (e.g., benefits of vaccines, altruistic attitudes), and COVID-19 health beliefs and experiences (COVID-19 worry and severity, perception of COVID-19 as a community threat, knowing someone with COVID-19). For each group, hierarchical multivariable logistic regression was conducted with intent to vaccinate as the outcome. RESULTS Among participants (n = 3502), 47% did not receive influenza vaccine in the prior 12 months and 53% had; 25.5% of non-vaccinators and 91.9% of vaccinators intended future vaccination. For non-vaccinators, odds of intending vaccination was associated with race/ethnicity (Hispanics were more likely to intend than white-NH; AOR = 1.74; 95% CI = 1.23-2.4), greater perceived benefits of vaccination (AOR = 2.19; 95% CI = 1.88-2.54), and perception of COVID-19 as a community threat (AOR = 1.91; 95% CI = 1.49-2.45). For vaccinators, odds of intending vaccination was associated with age (AOR = 1.04; 95% CI = 1.03-1.05), race/ethnicity (Black-NH and Other-NH were less likely to intend than white-NH, AOR = 0.60; 95% CI = 0.36-0.999; and AOR = 0.45; 95% CI = 0.24-0.84, respectively), greater perceived benefits of vaccination (AOR = 1.88; 95% CI = 1.45-2.45) and greater perception of collective benefits of vaccines (AOR = 1.48; 95% CI = 1.15-1.90). CONCLUSIONS The COVID-19 pandemic may have served as a cue to action for influenza vaccination intention among some prior non-vaccinators whereas intention among prior vaccinators is more related to positive attitudes toward vaccination.
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Affiliation(s)
- Lynne Sturm
- Indiana University School of Medicine, Department of Pediatrics, Suite 3120 Riley Pediatric Care Center, 1002 Wishard Boulevard, Indianapolis, IN 46202, USA.
| | - Monica L Kasting
- Purdue University, Department of Public Health, Matthews Hall 216, 812 W. State Street, West Lafayette, IN 47907, USA.
| | - Katharine J Head
- Indiana University, Purdue University Indianapolis, Department of Communication Studies, 307C Cavanaugh Hall, 425 University Blvd, Indianapolis, IN, 46202 USA.
| | - Jane A Hartsock
- Indiana University Health, 1800 N. Capitol Ave., Noyes Pavilion Suite E644, Indianapolis, IN 46202, USA.
| | - Gregory D Zimet
- Indiana University School of Medicine, Department of Pediatrics, 410 W. 10th Street. Ste 1001, Indianapolis, IN 46202, USA.
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16
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Flores LE, Frontera WR, Andrasik MP, del Rio C, Mondríguez-González A, Price SA, Krantz EM, Pergam SA, Silver JK. Assessment of the Inclusion of Racial/Ethnic Minority, Female, and Older Individuals in Vaccine Clinical Trials. JAMA Netw Open 2021; 4:e2037640. [PMID: 33606033 PMCID: PMC7896193 DOI: 10.1001/jamanetworkopen.2020.37640] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022] Open
Abstract
Importance Medical research has not equitably included members of racial/ethnic minority groups or female and older individuals. There are limited data on participant demographic characteristics in vaccine trials despite the importance of these data to current trials aimed at preventing coronavirus disease 2019. Objective To investigate whether racial/ethnic minority groups and female and older adults are underrepresented among participants in vaccine clinical trials. Design, Setting, and Participants This cross-sectional study examined data from completed US-based vaccine trials registered on ClinicalTrials.gov from July 1, 2011, through June 30, 2020. The terms vaccine, vaccination, immunization, and inoculation were used to identify trials. Only those addressing vaccine immunogenicity or efficacy of preventative vaccines were included. Main Outcomes and Measures The numbers and percentages of racial/ethnic minority, female, and older individuals compared with US census data from 2011 and 2018. Secondary outcome measures were inclusion by trial phase and year of completion. Results A total of 230 US-based trials with 219 555 participants were included in the study. Most trials were randomized (180 [78.3%]), included viral vaccinations (159 [69.1%]), and represented all trial phases. Every trial reported age and sex; 134 (58.3%) reported race and 79 (34.3%) reported ethnicity. Overall, among adult study participants, White individuals were overrepresented (77.9%; 95% CI, 77.4%-78.4%), and Black or African American individuals (10.6%; 95% CI, 10.2%-11.0%) and American Indian or Alaska Native individuals (0.4%; 95% CI, 0.3%-0.5%) were underrepresented compared with US census data; enrollment of Asian individuals was similar (5.7%; 95% CI, 5.5%-6.0%). Enrollment of Hispanic or Latino individuals (11.6%; 95% CI, 11.1%-12.0%) was also low even among the limited number of adult trials reporting ethnicity. Adult trials were composed of more female participants (75 325 [56.0%]), but among those reporting age as a percentage, enrollment of participants who were aged 65 years or older was low (12.1%; 95% CI, 12.0%-12.3%). Black or African American participants (10.1%; 95% CI, 9.7%-10.6%) and Hispanic or Latino participants (22.5%; 95% CI, 21.6%-23.4%) were also underrepresented in pediatric trials. Among trials reporting race/ethnicity, 65 (48.5%) did not include American Indian or Alaska Native participants and 81 (60.4%) did not include Hawaiian or Pacific Islander participants. Conclusions and Relevance This cross-sectional study found that among US-based vaccine clinical trials, members of racial/ethnic minority groups and older adults were underrepresented, whereas female adults were overrepresented. These findings suggest that diversity enrollment targets should be included for all vaccine trials targeting epidemiologically important infections.
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Affiliation(s)
- Laura E. Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha
| | - Walter R. Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine and Department of Physiology, University of Puerto Rico School of Medicine, San Juan
| | - Michele P. Andrasik
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Carlos del Rio
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Rollin School of Public Health of Emory University, Atlanta, Georgia
| | | | | | - Elizabeth M. Krantz
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Steven A. Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
- Spaulding Rehabilitation Hospital, Charlestown, Massachusetts
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston
- Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, Massachusetts
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17
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Racial and geographic disparities in influenza vaccination in the U.S. among individuals with atherosclerotic cardiovascular disease: Renewed importance in the setting of COVID-19. Am J Prev Cardiol 2021; 5:100150. [PMID: 33521756 PMCID: PMC7826080 DOI: 10.1016/j.ajpc.2021.100150] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction The importance of receiving an annual influenza vaccine among patients with atherosclerotic cardiovascular disease (ASCVD) is well established. With the rapid community spread and the possibility of another wave of COVID-19 infections in the fall, receiving an influenza vaccine is of particular importance to mitigate the risk associated with overlapping influenza and COVID-19 infections. Methods We utilized cross-sectional data from the 2016 to 2019 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative U.S. telephone-based survey of adults 18 years or older. Race/ethnicity was our exposure of interest. We assessed the relative difference in influenza vaccination by race/ethnicity for each U.S. state in the overall U.S. population and among those with ASCVD as prevalence of receipt of influenza vaccination among Blacks or Hispanics minus prevalence among Whites divided by prevalence among Whites. We used multivariable-adjusted logistic regression models to evaluate the association between socioeconomic risk factors and receipt of influenza vaccination. Results The study population consisted of 1,747,397 participants of whom 21% were older than 65 years, 51% women, 63% White, 12% Black, 17% Hispanic, and 9% with history of ASCVD. The receipt of influenza vaccine was 38% in the overall population and 51% among those with self-reported ASCVD, which translates to approximately to 97 million and 12 million US adults, respectively. The receipt of influenza vaccine among individuals with ASCVD was 54% for Whites, 45% for Blacks, and 42% for Hispanics (p<0.001). In the overall U.S. population, the median (interquartile range) relative difference for influenza vaccination between Blacks and Whites was 17% (-27%, -9%) and –22% (-29%, -9%) between Hispanics and Whites across all U.S. states. Among individuals with and without ASCVD, age older than 65 years, greater than college education, higher income, and having a primary care physician were significantly associated with higher odds of receipt of influenza vaccination, while being employed, lack of healthcare coverage, Black race, and delay in healthcare access were significantly inversely associated with having received an influenza vaccine Conclusions Only 50% patients with ASCVD receive influenza vaccines. The receipt of influenza vaccination among individuals with ASCVD is lower among Blacks and Hispanics compared to Whites with significant state-level variation. There are important socioeconomic determinants that are associated with receipt of the influenza vaccine.
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Bazargan M, Wisseh C, Adinkrah E, Ameli H, Santana D, Cobb S, Assari S. Influenza Vaccination among Underserved African-American Older Adults. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2160894. [PMID: 33224975 PMCID: PMC7671800 DOI: 10.1155/2020/2160894] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Racial disparities in influenza vaccination among underserved minority older adults are a public health problem. Understanding the factors that impact influenza vaccination behaviors among underserved older African-Americans could lead to more effective communication and delivery strategies. AIMS We aimed to investigate rate and factors associated with seasonal influenza vaccination among underserved African-American older adults. We were particularly interested in the roles of demographic factors, socioeconomic status, and continuity and patient satisfaction with medical care, as well as physical and mental health status. METHODS This community-based cross-sectional study recruited 620 African-American older adults residing in South Los Angeles, one of the most under-resources areas within Los Angeles County, with a population of over one million. Bivariate and multiple regression analyses were performed to document independent correlates of influenza vaccination. RESULTS One out of three underserved African-American older adults aged 65 years and older residing in South Los Angeles had never been vaccinated against the influenza. Only 49% of participants reported being vaccinated within the 12 months prior to the interview. One out of five participants admitted that their health care provider recommended influenza vaccination. However, only 45% followed their provider's recommendations. Multivariate logistic regression shows that old-old (≥75 years), participants who lived alone, those with a lower level of continuity of care and satisfaction with the accessibility, availability, and quality of care, and participants with a higher number of depression symptoms were less likely to be vaccinated. As expected, participants who indicated that their physician had advised them to obtain a flu vaccination were more likely to be vaccinated. Our data shows that only gender was associated with self-report of being advised to have a flu shot. Discussion. One of the most striking aspects of this study is that no association between influenza vaccination and being diagnosed with chronic obstructive pulmonary disease or other major chronic condition was detected. Our study confirmed that both continuity of care and satisfaction with access, availability, and quality of medical care are strongly associated with current influenza vaccinations. We documented that participants with a higher number of depression symptoms were less likely to be vaccinated. CONCLUSION These findings highlight the role that culturally acceptable and accessible usual source of care van play as a gatekeeper to facilitate and implement flu vaccination among underserved minority older adults. Consistent disparities in influenza vaccine uptake among underserved African-American older adults, coupled with a disproportionate burden of chronic diseases, places them at high risk for undesired outcomes associated with influenza. As depression is more chronic/disabling and is less likely to be treated in African-Americans, there is a need to screen and treat depression as a strategy to enhance preventive care management such as vaccination of underserved African-American older adults. Quantification of associations between lower vaccine uptake and both depression symptoms as well as living alone should enable health professionals target underserved African-American older adults who are isolated and suffer from depression to reduce vaccine-related inequalities.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, California, USA
- Department of Public Health, CDU, Los Angeles, California, USA
- Physician Assistant Program, CDU, Los Angeles, California, USA
- Department of Family Medicine, UCLA, Los Angeles, California, USA
| | - Cheryl Wisseh
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, California, USA
- Department of Clinical Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of California at Irvine, California, USA
| | - Edward Adinkrah
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, California, USA
| | - Hoorolnesa Ameli
- Department of Emergency Medicine, Qom University of Medical Sciences, Gom, Iran
| | - Delia Santana
- School of Nursing, CDU, Los Angeles, California, USA
| | - Sharon Cobb
- School of Nursing, CDU, Los Angeles, California, USA
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, California, USA
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19
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Yan BW, Sloan FA, Dudley RA. How Influenza Vaccination Rate Variation Could Inform Pandemic-Era Vaccination Efforts. J Gen Intern Med 2020; 35:3401-3403. [PMID: 32857264 PMCID: PMC7453691 DOI: 10.1007/s11606-020-06129-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Brandon W Yan
- Philip R. Lee Institute for Health Policy Studies and School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Frank A Sloan
- Department of Economics, Sanford School of Public Policy, and Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - R Adams Dudley
- Philip R. Lee Institute for Health Policy Studies and School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.,School of Medicine, School of Public Health, and Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
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A Map of Racial and Ethnic Disparities in Influenza Vaccine Uptake in the Medicare Fee-for-Service Program. Adv Ther 2020; 37:2224-2235. [PMID: 32274750 PMCID: PMC7467464 DOI: 10.1007/s12325-020-01324-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Despite improved understanding of the risks of influenza and better vaccines for older patients, influenza vaccination rates remain subpar, including in high-risk groups such as older adults, and demonstrate significant racial and ethnic disparities. METHODS This study considers demographic, clinical, and geographic correlates of influenza vaccination among Medicare Fee-for-Service (FFS) beneficiaries in 2015-2016 and maps the data on a geographic information system (GIS) at the zip code level. RESULTS Analyses confirm that only half of the senior beneficiaries evidenced a claim for receiving an inactivated influenza vaccine (IIV), with significant disparities observed among black, Hispanic, rural, and poorer beneficiaries. More extensive disparities were observed for the high-dose (HD) vaccine, with its added protection for older populations and confirmed economic benefit. Most white beneficiaries received HD; no non-white subgroup did so. Mapping of the data confirmed subpar vaccination in vulnerable populations with wide variations at the zip code level. CONCLUSION Urgent and targeted efforts are needed to equitably increase IIV rates, thus protecting the most vulnerable populations from the negative health impact of influenza as well as the tax-paying public from the Medicare costs from failing to do so.
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Odoi EW, Nagle N, DuClos C, Kintziger KW. Disparities in Temporal and Geographic Patterns of Myocardial Infarction Hospitalization Risks in Florida. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4734. [PMID: 31783516 PMCID: PMC6926732 DOI: 10.3390/ijerph16234734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
Abstract
Knowledge of geographical disparities in myocardial infarction (MI) is critical for guiding health planning and resource allocation. The objectives of this study were to identify geographic disparities in MI hospitalization risks in Florida and assess temporal changes in these disparities between 2005 and 2014. This study used retrospective data on MI hospitalizations that occurred among Florida residents between 2005 and 2014. We identified spatial clusters of hospitalization risks using Kulldorff's circular and Tango's flexible spatial scan statistics. Counties with persistently high or low MI hospitalization risks were identified. There was a 20% decline in hospitalization risks during the study period. However, we found persistent clustering of high risks in the Big Bend region, South Central and southeast Florida, and persistent clustering of low risks primarily in the South. Risks decreased by 7%-21% in high-risk clusters and by 9%-28% in low-risk clusters. The risk decreased in the high-risk cluster in the southeast but increased in the Big Bend area during the last four years of the study. Overall, risks in low-risk clusters were ahead those for high-risk clusters by at least 10 years. Despite MI risk declining over the study period, disparities in MI risks persist. Eliminating/reducing those disparities will require prioritizing high-risk clusters for interventions.
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Affiliation(s)
- Evah W. Odoi
- Comparative and Experimental Medicine, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Nicholas Nagle
- Department of Geography, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Chris DuClos
- Environmental Public Health Tracking, Division of Community Health Promotion, Florida Department of Health, Tallahassee, FL 32399, USA;
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Vaccination Capability Inventory of Community, Migrant, and Homeless Health Centers: A Survey Report. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 26:139-147. [PMID: 31490854 DOI: 10.1097/phh.0000000000001073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Federally funded Community, Migrant, and Homeless Health Centers provide health services to the most vulnerable communities in the United States. However, little is known about their capabilities and processes for providing vaccinations to adults. PROGRAM We conducted the first national survey of health centers assessing their inventory, workflow, capacity for, and barriers to provision of routinely recommended adult vaccines. In addition, we asked health center leaders' perceptions regarding best practices and policy recommendations for adult vaccinations. IMPLEMENTATION A survey was developed on the basis of domains elicited from advisory panels and focus groups and was sent electronically to leaders of 762 health centers throughout the United States and its territories; data were collected and analyzed in 2018. EVALUATION A total of 319 survey responses (42%) were obtained. Health centers reported stocking most routinely recommended vaccines for adults; zoster vaccines were not stocked regularly due to supply and storage issues. Respondents most commonly reported adequate reimbursement for vaccination services from private insurance and Medicaid. Most vaccinations were provided during primary care encounters; less than half of health centers reported providing vaccines during specialist visits. Vaccines administered at the health center were most commonly documented in an open field of the electronic health record (96%) or in an immunization information system (72%). Recommendations for best practices related to better documentation of vaccinations and communication with immunization information systems were provided. DISCUSSION Health centers provide most adult vaccines to their patients despite financial and technological barriers to optimal provisioning. Further studies at point of care could help identify mechanisms for system improvements.
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McGrath LJ, Layton JB, Krueger WS, Kshirsagar AV, Butler AM. High-dose influenza vaccine use among patients receiving hemodialysis in the United States, 2010-2013. Vaccine 2018; 36:6087-6094. [PMID: 30195486 DOI: 10.1016/j.vaccine.2018.08.079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/26/2018] [Accepted: 08/30/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Standard influenza vaccines may be of limited benefit to patients with end-stage renal disease (ESRD). These patients may benefit from high-dose influenza vaccine, currently indicated for patients aged ≥65 years. Studies in other populations have demonstrated that high-dose vaccine elicits a stronger immunological response. We compared vaccine uptake in the United States and predictors of receipt for high-dose and standard influenza vaccines. METHODS Using data from the United States Renal Data System (2010-2013), we conducted a cohort study of 421,482 adult patients on hemodialysis. We examined temporal trends in uptake of high-dose or standard trivalent influenza vaccine each influenza season, and used multivariate logistic regression to assess the association between individual-level variables (e.g., demographics, comorbidities) and facility-level variables (e.g., facility size and type) with vaccine receipt. RESULTS The proportion of patients with ESRD who were vaccinated with any influenza vaccine increased from 68.3% in 2010 to 72.4% in 2013. High-dose vaccines were administered to 0.9% of patients during the study period, and 16.7% of high-dose vaccines were administered to patients <65 years of age. Among patients aged ≥65 years, older patients (>79 vs. 65-69 years: OR, 1.29; 95% CI, 1.19-1.41) and patients at hospital-based versus free-standing dialysis facilities (OR, 2.31; 95% CI, 2.13-2.45) were more likely to receive high-dose vaccine, while blacks (vs. whites [OR, 0.66; 95% CI, 0.61-0.71]) and patients with longer duration of ESRD (>9 vs. 0 years: OR, 0.66; 95% CI, 0.55-0.78) were less likely to receive the high-dose vaccine. CONCLUSIONS While the overall influenza vaccination rate has increased, use of high-dose vaccine among patients with ESRD was very low. Being an older patient, living in the Midwest, and receiving care at hospital-based facilities were the strongest predictors of receiving high-dose vaccine.
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Affiliation(s)
| | - J Bradley Layton
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States; RTI Health Solutions, Research Triangle Park, NC, United States
| | | | - Abhijit V Kshirsagar
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, United States
| | - Anne M Butler
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, United States.
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Nowak GJ, Cacciatore MA, Len-Ríos ME. Understanding and Increasing Influenza Vaccination Acceptance: Insights from a 2016 National Survey of U.S. Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040711. [PMID: 29642624 PMCID: PMC5923753 DOI: 10.3390/ijerph15040711] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 11/16/2022]
Abstract
Background: The percentage of adults in the U.S. getting seasonal influenza vaccination has not changed significantly since 2013 and remains far below the federal government's 70% target. Objective: This study assessed and identified characteristics, experiences, and beliefs associated with influenza vaccination using a nationally representative survey of 1005 U.S. adults 19 years old and older. Methods: The sample was drawn from the National Opinion Research Center's AmeriSpeak Panel, a probability-based panel designed to be representative of the U.S. household population. Results: Overall, 42.3% received an influenza vaccination in the past 12 months, with rates highest for non-Hispanic Whites and Blacks and those 65 years old and older. Hispanic respondents and those under 64 years old were much less likely to get an influenza vaccination. They were also less aware of the recommendation, less informed about influenza and the benefits of vaccination, and least confident in the vaccine. Conclusions: Increasing influenza vaccination coverage in the U.S. requires a greater focus on 19-64 year-olds, particularly those 50 to 64, Hispanics and continued focus on those with diabetes and asthma. Efforts need to increase awareness of influenza vaccination recommendations, foster a sense of being well informed about influenza vaccination benefits and the risks associated with non-vaccination, and increase confidence that there are meaningful benefits from receiving an influenza vaccination.
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Affiliation(s)
- Glen J Nowak
- Center for Health and Risk Communication, Grady College of Journalism & Mass Communication, University of Georgia, 120 Hooper Street, Athens, GA 30602, USA.
| | - Michael A Cacciatore
- Center for Health and Risk Communication, Grady College of Journalism & Mass Communication, University of Georgia, 120 Hooper Street, Athens, GA 30602, USA.
| | - María E Len-Ríos
- Center for Health and Risk Communication, Grady College of Journalism & Mass Communication, University of Georgia, 120 Hooper Street, Athens, GA 30602, USA.
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Crouse Quinn S, Jamison AM, Freimuth VS, An J, Hancock GR. Determinants of influenza vaccination among high-risk Black and White adults. Vaccine 2017; 35:7154-7159. [PMID: 29126805 PMCID: PMC5712242 DOI: 10.1016/j.vaccine.2017.10.083] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/26/2017] [Accepted: 10/27/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adults with chronic conditions are at much greater risk of influenza-related morbidity and mortality, yet flu vaccine uptake remains suboptimal. Research focused on the high-risk population has been limited, particularly related to racial disparities in vaccination. We explore a broad range of demographic, racial, and psychosocial factors to identify predictors of vaccination among high-risk adults, with a focus on identify differences between Black and White adults. METHODS We conducted an online survey in March 2015, utilizing international research firm GfK's KnowledgePanel, for a nationally representative sample of Black and White adults (≥18, USA) and limited analysis adults with high-risk of influenza-related complications. Using two-way ANOVA, we assessed demographic, racial, and psychosocial predictors across vaccine uptake in the past five years and across racial group. RESULTS 424 (52.2%) Black and 388 (47.8%) White respondents with high-risk complications completed the survey. 383 (47.3%) reported vaccination annually, 99 (12.2%) most years, 104 (12.9%) once/twice, and 223 (27.6%) never.ANOVA confirmed significant differences in vaccine behavior for most demographic predictors (except education), all racial factors (including racial fairness, experiences of discrimination, etc.), and most psychosocial factors (including vaccine attitudes, trust in the vaccine, etc.). ANOVA confirmed significant differences for most factors by race. We observed significant interaction effects between race and vaccine behavior for subjective social status, access to medical care, knowledge of vaccine recommendations, vaccine attitudes, perceived side effect risks, descriptive norms, subjective norms, flu vaccine hesitancy, and flu vaccine confidence, thus implying racial differences in the connection between vaccine uptake and key demographic, racial, and psychosocial factors. CONCLUSIONS This study provides a novel examination of flu vaccine behavior among high-risk Blacks and Whites that identified factors influencing vaccine uptake.We found significant differences by race. Health care professionals can use this information to more effectively target high-risk adults during flu season.
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Affiliation(s)
- Sandra Crouse Quinn
- Department of Family Science, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742-2611, United States.
| | - Amelia M Jamison
- Maryland Center for Health Equity, University of Maryland, College Park, MD, United States
| | - Vicki S Freimuth
- Center for Health and Risk Communication (Emeritus), University of Georgia, Athens, GA, United States
| | - Ji An
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
| | - Gregory R Hancock
- Department of Human Development and Quantitative Methods, University of Maryland, College Park, MD, United States
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