Influenza Vaccination Among People With Medicare by Race and Ethnicity, Education, and Rurality

Influenza vaccination is a safe, effective way to mitigate influenza infection but remains underused by some groups, including older Black and Hispanic adults. There is concern that changing attitudes toward vaccination during the COVID-19 pandemic could decrease influenza vaccination rates.

To examine national patterns of influenza vaccination among older adults with Medicare, including analyses stratified by race and ethnicity, educational attainment, and rurality.

This retrospective, cross-sectional survey study of responses to the 2019 and 2022 Medicare Consumer Assessment of Healthcare Providers and Systems surveys used cross-sectional analysis for data from a weighted sample of 285 265 community-dwelling Medicare Advantage and Medicare Fee-for-Service enrollees aged 65 years or older living in the 50 US states and Washington, DC, who answered a survey question about influenza immunization.

Race and ethnicity, educational attainment, and rurality of survey respondents.

The primary outcome was self-reported influenza vaccination.

The weighted sample combining both years of data for 285 265 individuals included 54.5% women. A total of 4.2% were Asian American, Native Hawaiian, and Other Pacific Islander; 8.0% were Black; 6.9% were Hispanic; and 76.2% were White. Between 2019 and 2022, overall influenza vaccination rates for older adults increased by 0.7 percentage points (95% CI, 0.2-1.1 percentage points), from 76.3% to 77.0%. Whereas influenza vaccination rates for Asian American, Native Hawaiian, and Other Pacific Islander older adults (from 81.2% to 83.1%) and White older adults (from 77.7% to 77.9%) were essentially unchanged between 2019 and 2022, they increased by 3.8 percentage points (95% CI, 1.8-5.7 percentage points) for Black older adults (from 66.9% to 70.7%) and 2.3 percentage points (95% CI, 0.5-4.0 percentage points) for Hispanic older adults (from 72.7% to 75.0%). Black and Hispanic older adults living in rural areas had the largest increases during this period (Black, 7.0 percentage points [95% CI, 0.3-13.8 percentage points]; Hispanic, 8.2 percentage points [95% CI, 0.8-15.5 percentage points]), while White older adults with lower educational attainment and/or living in rural areas had decreases in vaccination rates (White with lower educational attainment, -1.9 percentage points [95% CI, -2.8 to -1.0 percentage points]; White living in rural areas, -2.0 percentage points [95% CI, -3.2 to -0.8 percentage points]; White with lower educational attainment and living in rural areas, -3.7 percentage points [95% CI, -5.5 to -1.9 percentage points]).

In this cross-sectional survey study, although overall influenza vaccination rates changed little from 2019 to 2022, they increased substantially for Black and Hispanic older adults, particularly those in rural areas, and decreased for some groups of White older adults. Determining the reasons for these divergent changes in influenza vaccination rates is a high priority for future research.