Comparison of racial/ethnic disparities in adult immunization and cancer screening

Racial/ethnic disparities in adult influenza and pneumococcal vaccination are marked and poorly understood. The purpose of this study was to contrast these disparities with disparities in other clinical preventive services--mammography and colorectal cancer screening--that are targeted to older populations.

Data from the 2000 National Health Interview Survey were analyzed in 2004 to determine to what degree race/ethnicity remains a predictor of the receipt of each service after adjusting for personal and health characteristics, socioeconomic status (SES), and access to and utilization of care variables.

Blacks and Hispanics were significantly less likely to report receipt of nearly all preventive services examined. Among whites, 57%, 67%, 67%, and 40% reported pneumococcal vaccination, influenza vaccination, mammography, and colorectal cancer screening, respectively. Among blacks, those proportions were 31%, 48%, 60% and 33%, respectively; among English-speaking Hispanics, 35%, 60%, 60%, and 30%, respectively; and among Spanish-speaking Hispanics, 24%, 49%, 52%, and 19%, respectively. After adjusting for personal and health characteristics, socioeconomic factors, and measures of access to and utilization of care, blacks and English- and Spanish-speaking Hispanics remained significantly less likely than whites to report the receipt of pneumococcal vaccination; blacks remained significantly less likely to report influenza vaccination than whites; and Spanish-speaking Hispanics remained significantly less to report colorectal cancer screening than whites.

Most racial/ethnic disparities seen in breast and colorectal cancer screening are explained by differences in SES. In contrast, racial/ethnic disparities in adult immunization persist, and especially for pneumococcal vaccination, suggesting that different barriers may be involved.