Influenza and Pneumococcus Vaccinations: Racial Disparities
Influenza and Pneumococcus Vaccinations: Racial Disparities
Objectives. We examined racial disparities in receipt and documentation of influenza and pneumococcus vaccinations among nursing-home residents.
Methods. We performed secondary analyses of data from a nationally representative survey of White (n=11448) and Black (n=1174) nursing-home residents in 2004. Bivariate and multivariate analyses determined racial disparities in receipt of influenza vaccination in 2003 and 2004, receipt of pneumococcus vaccination ever, and having a documented history for each vaccination.
Results. The overall vaccination rate was 76.2% for influenza and 48.5% for pneumococcus infection. Compared with Whites, Blacks showed a 13% lower vaccination rate and a 5% higher undocumentation rate for influenza, and a 15% lower vaccination rate and a 7% higher undocumentation rate for pneumococcus. For influenza, the odds ratio (OR) for Blacks being unvaccinated was 1.84 (P≤.001), and the OR for Blacks having undocumented vaccination was 1.85 (P=.001). For pneumococcus infection, the OR for Blacks being unvaccinated was 1.70 (P≤.001), and the OR for Blacks having undocumented vaccination was 1.95 (P≤.001). Stratified analyses confirmed persistent racial disparities among subpopulations.
Conclusions. Racial disparities exist in vaccination coverage among US nursing-home residents. Targeted interventions to improve vaccination coverage for minority nursing-home residents are warranted.
The nation's 1.6 million nursing-home residents are particularly vulnerable to influenza and pneumococcus infections because of their advanced age, increased level of functional disability, and presence of multiple chronic conditions such as diabetes, asthma, and heart or lung disease. Among Americans aged 65 years and older, every year influenza causes 190000 excess hospitalizations and 33000 deaths, and pneumonia causes 3400 deaths. Vaccinations against these infections are generally efficacious, safe, and cost-effective in nursing homes. For more than10 years the federal Advisory Committee on Immunization Practices has recommended universal influenza and pneumococcus vaccinations in nursing homes. However, previous estimates show that nursing home immunization coverage is only 60% for influenza and 40% for pneumococcus bacteria infection. In addition, the vaccination history of a sizable number of nursing-home residents is not routinely assessed, tracked, or documented, further preventing them from receiving appropriate vaccines.
Racial minorities make up about 16% of the nursing-home population, and minorities tend to be cared for in resource-poor facilities characterized by predominance of Medicaid reimbursement, less staffing by registered nurses, and higher rates of care deficiencies. Nevertheless, despite the considerable evidence substantiating racial disparities in vaccine uptake among populations in the larger community, little is known about the extent to which minority nursing-home residents receive suboptimal care, either preventive care or broader aspects of institutionalized care. Only1study has tried to examine racial differences in pneumococcal vaccination in this setting. That study was based on data from the 1997–1999 National Nursing Home Surveys (NNHSs) and reported inconsistent results across facilities.
The purpose of our study was to characterize racial disparities in influenza and pneumococcus immunizations in a more recent and nationally representative sample of nursing-home residents. We tested whether Black residents were less likely than were Whites (1) to receive each vaccination and (2) to have a documented status for each vaccination, either in the overall nursing-home population or in subpopulations defined by key demographic or facility characteristics.
Abstract and Introduction
Abstract
Objectives. We examined racial disparities in receipt and documentation of influenza and pneumococcus vaccinations among nursing-home residents.
Methods. We performed secondary analyses of data from a nationally representative survey of White (n=11448) and Black (n=1174) nursing-home residents in 2004. Bivariate and multivariate analyses determined racial disparities in receipt of influenza vaccination in 2003 and 2004, receipt of pneumococcus vaccination ever, and having a documented history for each vaccination.
Results. The overall vaccination rate was 76.2% for influenza and 48.5% for pneumococcus infection. Compared with Whites, Blacks showed a 13% lower vaccination rate and a 5% higher undocumentation rate for influenza, and a 15% lower vaccination rate and a 7% higher undocumentation rate for pneumococcus. For influenza, the odds ratio (OR) for Blacks being unvaccinated was 1.84 (P≤.001), and the OR for Blacks having undocumented vaccination was 1.85 (P=.001). For pneumococcus infection, the OR for Blacks being unvaccinated was 1.70 (P≤.001), and the OR for Blacks having undocumented vaccination was 1.95 (P≤.001). Stratified analyses confirmed persistent racial disparities among subpopulations.
Conclusions. Racial disparities exist in vaccination coverage among US nursing-home residents. Targeted interventions to improve vaccination coverage for minority nursing-home residents are warranted.
Introduction
The nation's 1.6 million nursing-home residents are particularly vulnerable to influenza and pneumococcus infections because of their advanced age, increased level of functional disability, and presence of multiple chronic conditions such as diabetes, asthma, and heart or lung disease. Among Americans aged 65 years and older, every year influenza causes 190000 excess hospitalizations and 33000 deaths, and pneumonia causes 3400 deaths. Vaccinations against these infections are generally efficacious, safe, and cost-effective in nursing homes. For more than10 years the federal Advisory Committee on Immunization Practices has recommended universal influenza and pneumococcus vaccinations in nursing homes. However, previous estimates show that nursing home immunization coverage is only 60% for influenza and 40% for pneumococcus bacteria infection. In addition, the vaccination history of a sizable number of nursing-home residents is not routinely assessed, tracked, or documented, further preventing them from receiving appropriate vaccines.
Racial minorities make up about 16% of the nursing-home population, and minorities tend to be cared for in resource-poor facilities characterized by predominance of Medicaid reimbursement, less staffing by registered nurses, and higher rates of care deficiencies. Nevertheless, despite the considerable evidence substantiating racial disparities in vaccine uptake among populations in the larger community, little is known about the extent to which minority nursing-home residents receive suboptimal care, either preventive care or broader aspects of institutionalized care. Only1study has tried to examine racial differences in pneumococcal vaccination in this setting. That study was based on data from the 1997–1999 National Nursing Home Surveys (NNHSs) and reported inconsistent results across facilities.
The purpose of our study was to characterize racial disparities in influenza and pneumococcus immunizations in a more recent and nationally representative sample of nursing-home residents. We tested whether Black residents were less likely than were Whites (1) to receive each vaccination and (2) to have a documented status for each vaccination, either in the overall nursing-home population or in subpopulations defined by key demographic or facility characteristics.