tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2022 Nov 24;9(12)
fac634.
doi: 10.1093/ofid/ofac634. eCollection 2022 Dec.
Geographic Variation in Influenza Vaccination Disparities Between Hispanic and Non-Hispanic White US Nursing Home Residents
Melissa R Riester[SUP] 1 2 [/SUP], Anthony I Roberts[SUP] 1 2 [/SUP], Joe B B Silva[SUP] 1 2 [/SUP], Chanelle J Howe[SUP] 3 4 [/SUP], Barbara H Bardenheier[SUP] 1 2 3 5 [/SUP], Robertus van Aalst[SUP] 1 6 7 [/SUP], Matthew M Loiacono[SUP] 8 [/SUP], Andrew R Zullo[SUP] 1 2 3 9 [/SUP]
Affiliations
Abstract
Background: Disparities in influenza vaccination exist between Hispanic and non-Hispanic White US nursing home (NH) residents, but the geographic areas with the largest disparities remain unknown. We examined how these racial/ethnic disparities differ across states and hospital referral regions (HRRs).
Methods: This retrospective cohort study included >14 million short-stay and long-stay US NH resident-seasons over 7 influenza seasons from October 1, 2011, to March 31, 2018, where residents could contribute to 1 or more seasons. Residents were aged ≥65 years and enrolled in Medicare fee-for-service. We used the Medicare Beneficiary Summary File to ascertain race/ethnicity and Minimum Data Set assessments for influenza vaccination. We calculated age- and sex-standardized percentage point (pp) differences in the proportions vaccinated between non-Hispanic White and Hispanic (any race) resident-seasons. Positive pp differences were considered disparities, where the proportion of non-Hispanic White residents vaccinated was greater than the proportion of Hispanic residents vaccinated. States and HRRs with ≥100 resident-seasons per age-sex stratum per racial/ethnic group were included in analyses.
Results: Among 7 442 241 short-stay resident-seasons (94.1% non-Hispanic White, 5.9% Hispanic), the median standardized disparities in influenza vaccination were 4.3 pp (minimum, maximum: 0.3, 19.2; n = 22 states) and 2.8 pp (minimum, maximum: -3.6, 10.3; n = 49 HRRs). Among 6 758 616 long-stay resident-seasons (93.7% non-Hispanic White, 6.5% Hispanic), the median standardized differences were -0.1 pp (minimum, maximum: -4.1, 11.4; n = 18 states) and -1.8 pp (minimum, maximum: -6.5, 7.6; n = 34 HRRs).
Conclusions: Wide geographic variation in influenza vaccination disparities existed across US states and HRRs. Localized interventions targeted toward areas with high disparities may be a more effective strategy to promote health equity than one-size-fits-all national interventions.
Keywords: ethnic groups; health care disparities; influenza; nursing homes; vaccines.
. 2022 Nov 24;9(12)
fac634.doi: 10.1093/ofid/ofac634. eCollection 2022 Dec.
Geographic Variation in Influenza Vaccination Disparities Between Hispanic and Non-Hispanic White US Nursing Home Residents
Melissa R Riester[SUP] 1 2 [/SUP], Anthony I Roberts[SUP] 1 2 [/SUP], Joe B B Silva[SUP] 1 2 [/SUP], Chanelle J Howe[SUP] 3 4 [/SUP], Barbara H Bardenheier[SUP] 1 2 3 5 [/SUP], Robertus van Aalst[SUP] 1 6 7 [/SUP], Matthew M Loiacono[SUP] 8 [/SUP], Andrew R Zullo[SUP] 1 2 3 9 [/SUP]
Affiliations
- PMID: 36540392
- PMCID: PMC9757686
- DOI: 10.1093/ofid/ofac634
Abstract
Background: Disparities in influenza vaccination exist between Hispanic and non-Hispanic White US nursing home (NH) residents, but the geographic areas with the largest disparities remain unknown. We examined how these racial/ethnic disparities differ across states and hospital referral regions (HRRs).
Methods: This retrospective cohort study included >14 million short-stay and long-stay US NH resident-seasons over 7 influenza seasons from October 1, 2011, to March 31, 2018, where residents could contribute to 1 or more seasons. Residents were aged ≥65 years and enrolled in Medicare fee-for-service. We used the Medicare Beneficiary Summary File to ascertain race/ethnicity and Minimum Data Set assessments for influenza vaccination. We calculated age- and sex-standardized percentage point (pp) differences in the proportions vaccinated between non-Hispanic White and Hispanic (any race) resident-seasons. Positive pp differences were considered disparities, where the proportion of non-Hispanic White residents vaccinated was greater than the proportion of Hispanic residents vaccinated. States and HRRs with ≥100 resident-seasons per age-sex stratum per racial/ethnic group were included in analyses.
Results: Among 7 442 241 short-stay resident-seasons (94.1% non-Hispanic White, 5.9% Hispanic), the median standardized disparities in influenza vaccination were 4.3 pp (minimum, maximum: 0.3, 19.2; n = 22 states) and 2.8 pp (minimum, maximum: -3.6, 10.3; n = 49 HRRs). Among 6 758 616 long-stay resident-seasons (93.7% non-Hispanic White, 6.5% Hispanic), the median standardized differences were -0.1 pp (minimum, maximum: -4.1, 11.4; n = 18 states) and -1.8 pp (minimum, maximum: -6.5, 7.6; n = 34 HRRs).
Conclusions: Wide geographic variation in influenza vaccination disparities existed across US states and HRRs. Localized interventions targeted toward areas with high disparities may be a more effective strategy to promote health equity than one-size-fits-all national interventions.
Keywords: ethnic groups; health care disparities; influenza; nursing homes; vaccines.