Introduction
Adults from racial and ethnic minorities and low-income groups are disproportionately
affected by vaccine-preventable diseases. The objective of this study is to examine
the trends in adult vaccination coverage in the U.S. by race/ethnicity and SES from
2010 to 2019.
Methods
Temporal trends in influenza; pneumococcal; herpes zoster; and tetanus, diphtheria,
and acellular pertussis vaccination coverage were examined by race/ethnicity and SES
in 2020 using the National Health Interview Surveys from 2010 to 2019.
Results
Influenza vaccination coverage differed by race/ethnicity among adults aged ≥65 years
(61.4% for Black, 63.9% for Hispanic, 71.9% for Asian, and 72.4% for White adults).
Race/ethnicity, household income, education level, and health insurance type were
significantly associated with receipt of influenza; pneumococcal; tetanus, diphtheria,
and acellular pertussis; and zoster vaccinations among adults aged ≥65 years in a
multivariable-adjusted regression model. Socioeconomic differences in influenza vaccine
uptake narrowed among adults aged 18–64 years from 2010 to 2019. By contrast, racial/ethnic
and socioeconomic differences in vaccine uptake persisted from 2010 to 2019 among
adults aged ≥65 years.
Conclusions
Racial and ethnic disparities in vaccine uptake persisted over the last decade. Socioeconomic
disparities in influenza vaccine coverage narrowed among adults aged 18–64 years;
however, disparities persisted among adults aged ≥65 years. Efforts are urgently needed
to achieve equity in immunization rates.
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REFERENCES
Immunization and infectious diseases. Healthy People 2020 , HHS, Office of Disease Prevention and Health promotion. https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases. Updated June 11, 2021. Accessed June 14, 2021.
Disease burden of influenza. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. https://www.cdc.gov/flu/about/burden/index.html. Updated October 5, 2020. Accessed April 9, 2021.
- Influenza-related hospitalizations and poverty levels - United States, 2010-2012.MMWR Morb Mortal Wkly Rep. 2016; 65: 101-105https://doi.org/10.15585/mmwr.mm6505a1
- Healthcare utilization and cost of pneumococcal disease in the United States.Vaccine. 2011; 29: 3398-3412https://doi.org/10.1016/j.vaccine.2011.02.088
- Disparities in incidence of COVID-19 among underrepresented racial/ethnic groups in counties identified as hotspots during June 5–18, 2020 - 22 states, February–June 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 1122-1126https://doi.org/10.15585/mmwr.mm6933e1
- Racial and ethnic disparities in vaccination coverage among adult populations in the U.S..Vaccine. 2015; 33: D83-D91https://doi.org/10.1016/j.vaccine.2015.09.031
- Seasonal influenza vaccination coverage trends among adult populations, U.S., 2010-2016.Am J Prev Med. 2019; 57: 458-469https://doi.org/10.1016/j.amepre.2019.04.007
- Meeting the challenges of immunizing adults.Am J Prev Med. 2015; 49: S455-S464https://doi.org/10.1016/j.amepre.2015.08.014
- The Affordable Care Act at 10 years - its coverage and access provisions.N Engl J Med. 2020; 382: 963-969https://doi.org/10.1056/NEJMhpr1916091
National Health Interview Survey. National Center for Health Statistics, Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/nhis/index.htm. Updated June 2, 2021. Accessed June 14, 2021.
- National Center for Health Statistics guidelines for analysis of trends.Vital Health Stat 2. 2018; : 1-71https://www.cdc.gov/nchs/data/series/sr_02/sr02_179.pdfDate accessed: June 14, 2021
- Reduction of racial/ethnic disparities in vaccination coverage, 1995-2011.MMWR Suppl. 2014; 63: 7-12https://www.cdc.gov/mmwr/preview/mmwrhtml/su6301a3.htmDate accessed: June 14, 2021
- Promoting prevention under the Affordable Care Act.Annu Rev Public Health. 2018; 39: 507-524https://doi.org/10.1146/annurev-publhealth-040617-013534
- Changes in self-reported insurance coverage, access to care, and health under the Affordable Care Act.JAMA. 2015; 314: 366-374https://doi.org/10.1001/jama.2015.8421
- U.S. physicians’ perspective of adult vaccine delivery.Ann Intern Med. 2014; 160: 161https://doi.org/10.7326/M13-2332
- Primary care physicians’ perspective on financial issues and adult immunization in the era of the Affordable Care Act.Vaccine. 2017; 35: 647-654https://doi.org/10.1016/j.vaccine.2016.12.007
- Improving adult immunization equity: where do the published research literature and existing resources lead?.Vaccine. 2017; 35: 3020-3025https://doi.org/10.1016/j.vaccine.2017.02.016
- A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care.J Gen Intern Med. 2012; 27: 992-1000https://doi.org/10.1007/s11606-012-2082-9
- Primary care physicians who treat blacks and whites.N Engl J Med. 2004; 351: 575-584https://doi.org/10.1056/NEJMsa040609
- Racial disparities in the quality of care for enrollees in medicare managed care.JAMA. 2002; 287: 1288-1294https://doi.org/10.1001/jama.287.10.1288
- Factors associated with vaccination of Medicare beneficiaries in five U.S. communities: results from the racial and ethnic adult disparities in immunization initiative survey, 2003.J Am Geriatr Soc. 2006; 54: 303-310https://doi.org/10.1111/j.1532-5415.2005.00585.x
- Perceptions matter: beliefs about influenza vaccine and vaccination behavior among elderly white, black and Hispanic Americans.Vaccine. 2012; 30: 6927-6934https://doi.org/10.1016/j.vaccine.2012.08.036
- The role of attitudes in understanding disparities in adult influenza vaccination.Am J Prev Med. 2006; 31: 281-285https://doi.org/10.1016/j.amepre.2006.06.025
- Trends in place of early-season influenza vaccination among adults, 2014–15 through 2018–19 influenza seasons-the importance of medical and nonmedical settings for vaccination.Am J Infect Control. 2021; 49: 555-562https://doi.org/10.1016/j.ajic.2020.09.016
- Increasing inner-city adult influenza vaccination rates: a randomized controlled trial.Public Health Rep. 2011; 126: 39-47https://doi.org/10.1177/00333549111260S206
- RCT of centralized vaccine reminder/recall for adults.Am J Prev Med. 2018; 55: 231-239https://doi.org/10.1016/j.amepre.2018.04.022
Immunization information systems (IIS). National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/programs/iis/index.html. Updated June 7, 2019. Accessed April 9, 2021.
- Racial similarities in response to standardized offer of influenza vaccination. a MetroNet study.J Gen Intern Med. 2006; 21: 346-351https://doi.org/10.1111/j.1525-1497.2006.00401.x
- Acceptance of pneumococcal vaccine under standing orders by race and ethnicity.J Natl Med Assoc. 2006; 98: 1089-1094
- Do vaccination strategies implemented by nursing homes narrow the racial gap in receipt of influenza vaccination in the United States?.J Am Geriatr Soc. 2011; 59: 687-693https://doi.org/10.1111/j.1532-5415.2011.03332.x
- Adult immunization: what can we learn from the childhood immunization program?.Clin Infect Dis. 2007; 44: 1532-1535https://doi.org/10.1086/519543
- Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients.Am J Prev Med. 1999; 16: 173-177https://doi.org/10.1016/s0749-3797(98)00159-7
- Sensitivity and specificity of patient self-report of influenza and pneumococcal polysaccharide vaccinations among elderly outpatients in diverse patient care strata.Vaccine. 2003; 21: 1486-1491https://doi.org/10.1016/s0264-410x(02)00700-4
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Published online: July 29, 2021
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
