Who are the elderly who never receive influenza immunization?
Introduction
To reduce morbidity and mortality associated with influenza and pneumonia, the advisory committee on immunization practices recommends an annual influenza immunization for all adults 50 years of age and older [1], [2]. To promote these guidelines, both Healthy People 2000 and Health People 2010 identified increasing the influenza and pneumococcal immunization levels [3], [4]. For example, Healthy People 2010 identified increasing the influenza immunization rates to 90% and higher among high-risk individuals including those aged 65 years and older as one of its objectives (objective 14.29) [4]. A review of the Health People 2000 progress in this priority area revealed that in 1997, all but six states and the District of Columbia had met or exceeded that target with respect to influenza immunization. However, an evaluation of the progress in 2001 revealed that influenza immunization levels during 2000–2001 decreased from 1998 to 1999 levels in 27 of 52 reporting areas [5]. In addition, it is suggested that increases in self-reported coverage levels for influenza immunization may have reached a plateau and new strategies may be needed to increase the rates further [6].
While previous studies have shed some light on racial disparities [5], [7], [8], [9], [10], [11], [12], [13], [14], [15], provider and patient attitudes [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], and access barriers [27], [28], [29], [30] in immunizations among older adults, many of these studies have been restricted to analysis on whether the respondents received annual influenza immunization. Our study extends existing research by comparing individuals who never received influenza immunization to others who reported annual or irregular immunizations. Knowledge of who the abstainers are helps to focus immunization outreach efforts. In this study, we examine individuals aged older than 50 years who never received influenza immunization with data from the nationally representative sample of households in the US. We also examine variations in lifetime nonreceipt of influenza immunization by socioeconomic status, race and ethnicity, health status, chronic illness, and access to care. Our paper focuses on individuals starting at age 51 years and older rather than 65, because the age for universal influenza immunization has been lowered from 65 to 50 years and increasing immunization coverage for high-risk persons younger than 65 years is now a high priority for expanding influenza vaccine use [31], [32].
Section snippets
Study sample
Our study sample is based on data from the household component of the 2000 Medical Expenditure Panel Survey. MEPS is a database of nationally representative data on health care use, expenditures, sources of payment, and insurance coverage for a non-institutionalized civilian population. Overall, the full 2000 MEPS sample consists of 9515 participating reporting units (where student RUs are linked to parent RUs for this count). These include 23,839 responding individuals that completed the full
Findings
Table 1 describes the elderly sample in 2000. The study sample consisted of 46% men and 54% women; 81% White, 9% African-American, 7% Latino, and 3% other. A majority (53%) was in the age group 51–64 years. Nearly two-thirds of the elderly were not married (63%). Only 24% had less than high school education, 14% were either poor or near poor, 6% had no health insurance, and 10% had no usual source of health care. An overwhelming majority of the elderly was in excellent or very good or good
Discussion
Despite well-defined recommendations and efforts to vaccinate persons at high risk, our study found that nearly one-third of the elderly never received influenza immunization. Our reported rates of immunization in the past year are somewhat lower than those published in the literature [43] because of inclusion of younger cohort aged 51 and older. In addition, our study findings point to racial, financial, and personal barriers associated with receipt of influenza immunizations. Although our
Acknowledgments
The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations. Work for this grant was partially supported by the Rutgers' NIMH-funded Center for Research on the Organization and Financing of Care for the Severely Mentally Ill, National Institutes of Mental Health, and Dr. Findley's K23 Award under the National Institute of Child Health and Human Development.
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Cited by (21)
Disparities in influenza vaccination across the United States: Variability by minority group, Asian sub-populations, socio-economic status, and health insurance coverage
2016, Public HealthCitation Excerpt :Non-Hispanic Blacks had the lowest coverage levels at 33.1%,13 and although not stated in the report, data were extrapolated to find an influenza coverage rate of 44.1% for Asian Indians.13 These disparities persist season-to-season4,15,17,23; however, significant attention has not been given to variability and trends in sub-groups, even though minority populations are overrepresented in the uninsured, leading to lower levels of influenza vaccine coverage across these sub-groups as compared to non-minority Whites Americans.24 One particular study linked health insurance coverage to these racial and ethnic characteristics and found that adult (minority) immigrants were significantly less likely to be up to date on vaccinations as compared to American-born individuals due to lack of health care access and low health care utilisation associated with country of origin, immigration status, and inability to speak and understand English.25
Cost-Effectiveness Analysis of a Television Campaign to Promote Seasonal Influenza Vaccination Among the Elderly
2015, Value in HealthCitation Excerpt :Potential determinants for racial/ethnic disparities are exemplified by racial/ethnic differences in perceptions about influenza vaccination [15]. For instance, the AA elderly had a distrust of the vaccine effectiveness [16] and hence were three times more likely to never receive influenza vaccination during their lifetime than were the W elderly [17]. Other determinants include less use of general preventive care among minority groups, provider bias, and differences in vaccine availability among minority groups [14,18].
Racial and ethnic disparities in influenza vaccinations among community pharmacy patients and non-community pharmacy respondents
2014, Research in Social and Administrative PharmacyCitation Excerpt :The influenza vaccination rates for Whites, Hispanics, and Blacks among non-community pharmacy respondents in the present study were 41.0%, 26.0% and 24.3%, respectively. Previous studies showed that Whites had higher influenza vaccination rates, which ranged from 52.4 to 82.1%, compared to Hispanics and Blacks, whose rates ranged from 39.9 to 79.0% and 32.2–70.9%, respectively.17,18,21–28 For instance, Sambamoorthi et al17 examined the predictors of influenza immunization among individuals aged 50 years or older, using the 2000 MEPS data.
Factors influencing acceptance of influenza vaccination given in an ED
2009, American Journal of Emergency Medicine