Do vaccination strategies implemented by nursing homes narrow the racial gap in receipt of influenza vaccination in the United States? (original) (raw)
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Clinical Infectious Diseases, 2020
Background. We sought to determine if racial differences in influenza vaccination among nursing home (NH) residents during the 2008-2009 influenza season persisted in 2018-2019. Methods. We conducted a cross-sectional study of NHs certified by the Centers for Medicare & Medicaid Services during the 2018-2019 influenza season in US states with ≥1% Black NH residents and a White-Black gap in influenza vaccination of NH residents (N = 2 233 392) of at least 1 percentage point (N = 40 states). NH residents during 1 October 2018 through 31 March 2019 aged ≥18 years and self-identified as being of Black or White race were included. Residents' influenza vaccination status (vaccinated, refused, and not offered) was assessed. Multilevel modeling was used to estimate facility-level vaccination status and inequities by state. Results. The White-Black gap in influenza vaccination was 9.9 percentage points. In adjusted analyses, racial inequities in vaccination were more prominent at the facility level than at the state level. Black residents disproportionately lived in NHs that had a majority of Blacks residents, which generally had the lowest vaccination. Inequities were most concentrated in the Midwestern region, also the most segregated. Not being offered the vaccine was negligible in absolute percentage points between White residents (2.6%) and Black residents (4.8%), whereas refusals were higher among Black (28.7%) than White residents (21.0%). Conclusions. The increase in the White-Black vaccination gap among NH residents is occurring at the facility level in more states, especially those with the most segregation.
Decomposing Racial and Ethnic Disparities in Nursing Home Influenza Vaccination
Journal of the American Medical Directors Association, 2021
This study examines the racial/ethnic disparity among nursing home (NH) residents using a self-reported, validated measure of quality of life (QoL) among long-stay residents in Minnesota. Blinder-Oaxaca decomposition techniques determine which resident and facility factors are the potential sources of the racial/ethnic disparities in QoL. Black, Indigenous, and other People of Color (BIPOC) report lower QoL than White residents. Facility structural characteristics and being a NH with a high proportion of residents who are BIPOC are the factors that have the largest explanatory share of the disparity. Modifiable characteristics like staffing levels explain a small share of the disparity. To improve the QoL of BIPOC NH residents, efforts need to focus on addressing systemic disparities for NHs with a high proportion of residents who are BIPOC.
Racial and ethnic disparities in influenza vaccination among elderly adults
Journal of General Internal Medicine, 2005
OBJECTIVES: To examine whether access to care factors account for racial/ethnic disparities in influenza vaccination among elderly adults in the United States. DESIGN: Indicators of access to care (predisposing, enabling, environmental/system, and health need) derived from Andersen's behavioral model were identified in the National Health Interview Survey questionnaire. The relationship of these indicators to influenza vaccination and race/ethnicity was assessed with multiple logistic regression models. MAIN RESULTS: Significant differences in vaccination were observed between non-Hispanic (NH) whites (66%) and Hispanics (50%, Po.001) and between NH whites (66%) and NH blacks (46%, Po.001). Controlling for predisposing and enabling access to care indicators, education, marital status, regular source of care, and number of doctor visits, reduced the prevalence odds ratios (POR) comparing Hispanics to non-Hispanic whites from 1.89 to 1.27. For NH blacks, controlling for access to care indicators changed the POR only from 2.24 (95% CI, 1.9 to 2.7) to 1.93 (95% CI, 1.6 to 2.4). CONCLUSIONS: This study confirmed the existence of sizable racial/ ethnic differences in influenza vaccination among elderly adults. These disparities were only partially explained by differences in indicators of access to care, especially among non-Hispanic blacks for whom large disparities remained. Factors not available in the National Health Interview Survey, such as patient attitudes and provider performance, should be investigated as possible explanations for the racial/ethnic disparity in influenza vaccination among non-Hispanic blacks.
Health Affairs, 2011
Vaccination is a key deterrent to influenza and its related complications and outcomes, including hospitalization and death. Using 2006-09 data, we found a small improvement in vaccination rates among nursing home residents, particularly for blacks. Nonetheless, overall vaccination rates remained well below the 90 percent target for high-quality care, and black nursing home residents remained less likely to be vaccinated than whites. Blacks were less likely to be vaccinated than were whites in the same facility and were more likely to live in facilities with lower vaccination rates. Blacks were also more likely to be noted as refusing vaccination. Strategies are needed to ensure that facilities offer vaccination to all residents and to make vaccination more acceptable to black residents and their families. Influenza can cause serious complications from existing medical conditions among the elderly, resulting in hospitalization and death. 1-3 The average number of influenza-related hospitalizations was estimated to be 186,029 a year among people age sixty-five and older between the 1979-80 and 2000-01 flu seasons. 1 Also, 90 percent of influenza-related respiratory and circulatory deaths occurred among the elderly between the 1976-77 and 1998-99 flu seasons. 3 Influenza among the elderly results in considerable medical costs. 4,5 The average annual cost for influenza-related hospitalizations among the elderly was estimated to be $372.3 million during the 1990-96 flu seasons. 5 Nursing home residents are vulnerable to influenza and complications because they are frail and live in an environment where the flu virus can easily spread. 6-8 The flu vaccination is the single most effective way to prevent influenza and related consequences-including hospitalization and death-among the elderly. 2,9 Consistent with the Healthy People 2010 goal of achieving 90 percent flu vaccination rates among the elderly, the Centers for Medicare and Medicaid Services (CMS) set a goal of 90 percent flu vaccination rate in nursing homes. CMS also mandated that all Medicare-or Medicaid-certified nursing homes ensure the vaccination of their residents and report
Racial similarities in response to standardized offer of influenza vaccination
Journal of General Internal Medicine, 2006
Despite known benefits of influenza vaccination and coverage by Medicare Part B, elderly minority patients are less likely to receive influenza vaccination than whites. To test whether a nonphysician-initiated standardized offer of influenza vaccination to all elderly primary care patients would result in similar proportions of African-American and white patients accepting vaccine. In 7 metropolitan Detroit primary care practices during the 2003 influenza vaccination season, medical assistants assessed influenza immunization status of all patients 65 years and older and collected limited demographic data. Eligible patients were offered vaccination. Proportion of patients accepting influenza vaccination by race and predictors of vaccine acceptance. Four hundred and fifty-four eligible patients with complete racial information were enrolled: 40% African American, 52% white, 8% other race/ethnicity. Similar proportions of African Americans and whites had already received the 2003 vaccine (11.6% and 11.0%, respectively) or stated vaccination as the reason for visit (23.8% and 30.5%, respectively). Among the remainder, there also were similar proportions who accepted vaccination: 68.9% white and 62.1% African-American patients. History of previous vaccination was the only statistically significant predictor of vaccine acceptance (odds ratio [OR] 8.64, 95% confidence interval [CI] 4.17, 17.91, P<.001). After adjusting for history of previous vaccination, age, gender, and education, the odds of vaccine acceptance were no different for whites and African Americans (OR 1.20, 95% CI 0.63, 2.29, P=.57). Vaccination acceptance differed little between African-American and white elderly patients. Using nonphysician personnel to identify and offer influenza vaccine to eligible patients is easily accomplished in primary care offices and has the potential to eliminate racial disparities in influenza vaccination.