Flu vaccination less common among elderly minorities

April 2007

Black and Hispanic patients aged 65 and older are less likely to receive influenza vaccine than white patients, according to a recent study.

Influenza vaccination can prevent up to 80% of deaths and up to 60% of influenza- and pneumonia-related hospitalizations in the elderly. Influenza vaccination rates have improved since 1993, when Medicare made the vaccine reimbursable, said Karen G. Wooten, a health scientist from the CDC. Morbidity and mortality associated with influenza have decreased as knowledge of and access to the vaccine increased, Wooten said, but vaccination is low in comparison to the national objective.

“If rates have in fact tapered off, we obviously have a lot of work to do to reach the national goal of 90% in 2010,” Wooten said.

Wooten and colleagues from the CDC and Spelman College, Atlanta, analyzed data from the 2004 National Adult Immunization Survey to identify common reasons for nonvaccination among the elderly.

Racial and ethnic disparity

Wooten and colleagues included 3,862 adults aged 65 and older in the study and weighted the data to account for population undercounts and nonresponses. They found that vaccination rates significantly differed by race or ethnicity. Seventy-seven percent of the white respondents reported receiving influenza vaccination compared with 54% of black respondents and 55% of Hispanic respondents (P<.01).

The most frequently reported reason respondents gave for receiving influenza vaccination was that they “did not want to get the flu,” according to the researchers. They found that 40% of white respondents, 26% of black respondents and 31% of Hispanic respondents gave this reason (P<.01).

Participants from each of the race groups sited concerns over influenza vaccine-related illnesses, including vaccine allergies, as the main reason for not receiving the vaccine (35% of white respondents, 35% of black respondents and 20% of Hispanic respondents). However, to have experienced adverse events related to previous vaccination was the only reason given by non-vaccinated respondents that differed statistically by race/ethnicity (8% of white respondents, 9% of black respondents and 3% of Hispanic respondents).

The researchers concluded that white patients were more likely to receive an influenza vaccine to prevent the illness and may be more motivated as a result of this belief. Black patients may be less likely to receive the vaccine because of concerns about illness following vaccination, according to the researchers.

“Differences in beliefs that influenza vaccine prevents influenza or causes sickness may be an important contribution to immunization disparity among the elderly,” the researchers said.

Wooten said that to increase vaccination among the elderly, public health strategies must address the public’s perception of the vaccine, including its effectiveness and common adverse events compared with rare adverse events. In addition, health care workers are key in increasing vaccination rates.

“Health care providers can have a tremendous effect on influenza vaccination rates by simply talking to their patients about the benefits of the vaccine, making the recommendation to get vaccinated and offering the vaccine to their patients. Even among adults with a low opinion of the vaccine, a recommendation from their physician carries a great deal of weight,” Wooten said.

This could further reduce some of the disparities regarding vaccination, since black respondents were more likely to report negative opinions about the vaccine.

“If we enhance our efforts to improve the public’s perception of the vaccine and our efforts to engage health care providers as partners, I believe we can reach the 2010 goal and significantly reduce racial disparity in influenza vaccination,” Wooten said.

For more information:

• Wooten KG, Peoples A, Singleton JA, et al. Reasons for vaccination and non-vaccination for influenza: Do they differ by race/ethnicity among the elderly? Abstract 31. Presented at: The 41st National Immunization Conference; March 5-8, 2007; Kansas City, Mo.