Influenza and Pneumococcal Vaccination of Adults Aged ≥65: Racial/Ethnic Differences

doi:10.1016/j.amepre.2005.08.012

American Journal of Preventive Medicine

Volume 29, Issue 5, December 2005, Pages 412-420

https://doi.org/10.1016/j.amepre.2005.08.012 Get rights and content

Background

Influenza and pneumococcal polysaccharide vaccination (PPV) rates among persons aged ≥65 years are significantly below national objectives of 90%, particularly among blacks and Hispanics. This study of the 2002–2003 influenza season examines factors that may be associated with low coverage.

Methods

A national sample of 1839 community-dwelling adults aged ≥65 years was surveyed by telephone during January–May 2003. Outcomes analyzed in 2004–2005 included self-reported influenza vaccination and PPV; place of vaccination; and among the unvaccinated, main reasons for nonvaccination, awareness of vaccination, and receipt of provider recommendation for vaccination.

Results

Influenza vaccine coverage was 67.8%, and PPV coverage was 60%. Coverage among blacks and Hispanics was ≥15 percentage points below that of whites. Half (52%) of persons who had not received PPV were aware it was recommended for persons their age, and <10% had received a recent physician recommendation for PPV. Concern about side effects and not thinking that they needed the vaccine were the most frequently cited reasons for not receiving an influenza vaccination. In each racial/ethnic group, prevalence of potential missed opportunities (recent doctor visit, but no vaccine recommendation from provider and no influenza vaccination) was higher than prevalence of potential vaccine refusal (recent doctor visit and vaccine recommendation from provider, but no vaccine): blacks, 26.9% versus 7.9%; Hispanics, 19.9% versus 12.1%; and white non-Hispanics, 16.2% versus 6.1%.

Conclusions

Improved adherence to vaccination guidelines by healthcare providers could substantially raise coverage in all racial/ethnic groups. Multiple factors contribute to racial/ethnic disparities, and their relative contributions should be further quantified.

Introduction

Persons aged ≥65 years are vulnerable to complications from influenza infection and invasive pneumococcal disease. During the 1980s and 1990s, severe cases of influenza and associated complications caused an annual average of approximately 186,000 excess respiratory and circulatory hospitalizations and 33,000 deaths among persons aged ≥65 years in the United States.1, 2 An estimated 3400 persons aged ≥65 died from invasive pneumococcal disease in the United States in 1998³; the incidence of invasive pneumococcal disease is higher for blacks compared to whites in this age group.⁴

Annual influenza vaccination and one-time pneumococcal polysaccharide vaccination (PPV) are recommended for people aged ≥65 years.5, 6 National objectives were set to achieve pneumococcal and annual influenza vaccination coverage among people aged ≥65 years of 60% by 2000, and 90% by 2010.7, 8 Medicare has reimbursed providers for the cost of these vaccines and their administration since 1993.9, 10 Despite recommendations, national objectives, guidance on interventions found to be most effective in raising vaccination coverage levels,¹¹ and efforts to promote vaccination, coverage remained stable during the 1997–2003 period at 65% to 70%.¹²

Racial/ethnic disparities in influenza and pneumococcal vaccination coverage persist among people aged ≥65 years,12, 13, 14, 15, 16, 17, 18, 19 even after control for demographic, socioeconomic, and healthcare factors.14, 15, 16, 17, 18, 19 These disparities may be related to differences in propensity to seek or accept vaccination; use of system strategies to facilitate vaccination by providers; or quantity and quality of patient–provider interactions.20, 21, 22, 23, 24, 25, 26, 27, 28

The 2003 National Adult Immunization Survey (NAIS) was conducted to gain further insight into reasons for racial/ethnic disparities in vaccination coverage. The NAIS was designed to provide national estimates by race/ethnicity of influenza vaccination and PPV coverage and reasons for nonvaccination among community-dwelling people aged ≥65 years in the United States. To assess potential missed opportunities for and refusal of vaccination, questions on recent doctor visits and receipt of provider recommendations for vaccination were included.

Section snippets

Sample

The NAIS sample was drawn from the first quarter of the 2003 National Immunization Survey (NIS) sampling frame.29, 30 The NIS provides annual national estimates of coverage for all recommended childhood vaccines among children aged 19 to 35 months. Data were collected between January 11, 2003 and May 24, 2003. Households with adults aged ≥65 years were eligible for participation in the NAIS. After determining the eligibility of the people in the household, one age-eligible adult was selected to

Response Rate

Entire interviews were completed with 1839 (97%) of 1891 adults aged ≥65 years. The overall Council of American Survey Research Organizations (CASRO) response rate was 58.2%, calculated as the product of the percent of telephone lines identified as residential (91.6%), percent of known households with completed screening interviews (81.1%), and the number of completed interviews divided by the number of sampled eligible respondents (78.3%).³¹

Proxy interviews were conducted for 144 selected

Discussion

In a national survey of people aged ≥65 years, influenza vaccine coverage for the 2002–2003 influenza season was 22 percentage points below the national year 2010 objective of 90%, and PPV coverage in 2003 was 30 percentage points below the same national objective. Coverage was significantly lower among Hispanics and blacks for recent influenza vaccination and lifetime pneumococcal vaccination. These findings are consistent with results of other national surveys.12, 16, 17, 18, 19

Coverage was

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Research articleInfluenza and Pneumococcal Vaccination of Adults Aged ≥65: Racial/Ethnic Differences

Background

Methods

Results

Conclusions

Introduction

Section snippets

Sample

Response Rate

Discussion

Prev Med

Am J Prev Med

Am J Prev Med

Vaccine

Am J Prev Med

Am J Prev Med

Prev Med

Am J Prev Med

Vaccine

Am J Med

Mortality associated with influenza and respiratory syncytial virus in the United States

JAMA

Influenza-associated hospitalizations in the United States

JAMA

Epidemiology of invasive Streptococcus pneumoniae infections in the United States, 1995–1998opportunities for prevention in the conjugate vaccine era

JAMA

Impact of childhood vaccination on racial disparities in invasive Streptococcus pneumoniae infections

JAMA

Prevention and control of influenzarecommendations of the Advisory Committee on Immunization Practices (ACIP)

MMWR Morb Mortal Wkly Rep

Prevention of pneumococcal diseaserecommendations of the Advisory Committee on Immunization Practices (ACIP)

MMWR Morb Mortal Wkly Rep

Healthy people 2000national health promotion and disease prevention objectives—full reports, with commentary

Healthy people 2010understanding and improving health

Implementation of the Medicare influenza vaccination benefit

MMWR Morb Mortal Wkly Rep

Pneumococcal vaccine

Vaccine-preventable diseases: improving vaccination coverage in children, adolescents, and adults. A report on recommendations of the Task Force on Community Preventive Services

MMWR Morb Mortal Wkly Rep

Pneumococcal pneumonia and influenza vaccinationaccess to and use by U.S. Hispanic Medicare beneficiaries

Am J Public Health

Racial disparity in influenza vaccination. Does managed care narrow the gap between African Americans and whites?

JAMA

Research article
Influenza and Pneumococcal Vaccination of Adults Aged ≥65: Racial/Ethnic Differences