Disparities in Adult Influenza Vaccination in the United States: Analysis of 2023 BRFSS Data

Despite longstanding recommendations for universal adult influenza vaccination, coverage remains suboptimal in the United States (U.S.). The objective of this study is to examine current influenza vaccination coverage and identify demographic, socioeconomic, and geographic disparities in vaccination among U.S. adults.

Cross-sectional analysis of 2023 Behavioral Risk Factor Surveillance System data from 402,005 adults across 52 states/territories. Survey-weighted logistic regression models assessed independent predictors of self-reported influenza vaccination in the past twelve months, including demographics, socioeconomic factors, healthcare access, and health status.

Overall vaccination coverage was 42.2% (95% CI 42.0-42.4%), well below the Healthy People 2030 target of 70%. Coverage increased markedly with age, from 29.2% among 18-24 year-olds to 66.9% among those ≥ 80 years of age. Women had higher coverage than men (45.4% vs. 38.7%, p < 0.001). Strong socioeconomic gradients emerged: coverage among college graduates (54.3%) exceeded that of those with less than a high school education (32.6%) and those earning ≥ $200,000 (53.5%) exceeded those earning < $15,000 (34.4%). Insurance status showed the largest disparity-45.1% of insured versus 16.2% of uninsured adults were vaccinated. Geographic variation was substantial, ranging from 19.1% in the Virgin Islands to 56.6% in Massachusetts. In multivariable analysis, the strongest predictors were advanced age (≥ 80 years: adjusted OR = 3.51, 95% CI 3.18-3.87), insurance coverage (adjusted OR = 1.74, 95% CI 1.57-1.93), and recent healthcare engagement (checkup within past year; adjusted OR = 1.62, 95% CI 1.53-1.73).

Influenza vaccination coverage remains far below national targets, with pronounced disparities across age, socioeconomic status, insurance coverage, and geography. These findings suggest that efforts to advance equity may benefit from addressing structural barriers, such as expanding insurance coverage, workplace vaccination programs, and targeted outreach to underserved populations; because the data are observational, these represent potential implications rather than conclusions about causal effects.