Immunization disparities in older Americans: determinants and future research needs

Area of Science:

• Public Health
• Health Disparities
• Vaccinology

Background:

• Significant racial disparities exist in influenza and pneumococcal vaccination rates among Medicare beneficiaries.
• These disparities highlight a critical gap in equitable healthcare access and outcomes.

Purpose of the Study:

• To analyze patient, physician, health system, and area-level factors contributing to racial disparities in adult immunization.
• To quantify the impact of these characteristics on vaccination rates in Medicare beneficiaries.

Main Methods:

• Cross-sectional and decomposition analyses were conducted on a national sample of Medicare beneficiaries (n=18,013) from 2000-2002.
• Data from the Medicare Current Beneficiary Survey (MCBS) included patient demographics, physician characteristics, health system factors, and area-level data.
• Outcomes measured were receipt of influenza and pneumococcal vaccines.

Main Results:

• Black beneficiaries had significantly lower odds of receiving influenza (aOR=1.52) and pneumococcal (aOR=1.82) vaccines compared to white beneficiaries, even after adjusting for multiple factors.
• Higher physician information-giving skills, practice accessibility, and a primary care generalist were associated with increased vaccination rates.
• Higher numbers of primary care physicians per elderly resident at the county level correlated with higher immunization rates.
• Only 7% of the racial disparity in influenza vaccination was explained by measured beneficiary and health system characteristics.

Conclusions:

• Black Medicare beneficiaries are less likely to receive crucial adult vaccinations compared to white beneficiaries, despite similar insurance and physician access.
• The study underscores the need for system-based interventions to integrate vaccination discussions and administration into routine care.
• Addressing these disparities requires a multi-faceted approach targeting systemic factors within healthcare delivery.