Introduction
Seasonal influenza vaccination among older adults is well below the recommendation
of Healthy People 2020. Although geographic disparities in influenza vaccination are well documented, it
remains unclear how community attributes correlate with influenza vaccination rates.
Social vulnerability measures play an important role in interventions addressing vaccine
equity; however, social vulnerability dimensions as corollaries of vaccination are
poorly understood. To inform vaccine equity interventions, this analysis investigates
spatially varying associations between county social vulnerability and influenza vaccination
rate among Medicare recipients.
Methods
County-level 2018 data (N=3,105) from the Centers for Disease Control and Prevention's
Social Vulnerability Index were merged with the percentage of Medicare recipients
vaccinated against influenza. Multilevel linear regression and geographically weighted
regression generated global and local estimates, adjusted for potential confounders.
Analyses were conducted in November 2020–April 2021.
Results
A 10-percentile point increase in the overall Social Vulnerability Index was associated
with an 0.87-point decrease in percentage vaccinated (p<0.001) with substantial variation by Social Vulnerability Index theme and geography.
A 10-percentile point increase in socioeconomic vulnerability was associated with
a 1.6-point decrease in vaccination (p<0.001) with stronger associations in higher Social Vulnerability Index quartiles
and in parts of the Midwest, South, and coastal Northeast. Other Social Vulnerability
Index themes had smaller associations with mixed directions: household composition
and disability estimates were negative, whereas estimates for minority status and
language and housing and transportation were positive.
Conclusions
Medicare recipients in socioeconomically vulnerable counties have low influenza vaccination
rates, particularly in select regions of the country. Best practices to improve vaccine
access and uptake should be targeted and should explicitly consider local socioeconomic
vulnerability.
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Article Info
Publication History
Published online: September 18, 2021
Identification
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
