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Improvements needed in flu vaccinations among black nursing home residents
Cai S. Health Aff. 2011;doi:10.1377/hlthaff.2011.0029.
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Despite recent improvements in influenza vaccination rates at nursing homes, black residents are less likely than white residents to receive the vaccine, according to researchers led by Shubing Cai, PhD.
“Blacks have lower vaccination rates than whites, both because they tend to reside in facilities that have lower vaccination rates, in general, and because they are less likely to get vaccinated in the same facility where white residents are vaccinated,” Cai, of the Center for Gerontology and Health Care Research at Brown University, and colleagues wrote in the study. “Strategies that reduce the vaccination rate differences between and within nursing homes are necessary in order to reduce those disparities and move closer toward the goal of a 90% flu vaccination rate for all nursing home residents.”
Patient records were pooled from three influenza seasons (between 2006 and 2009). Researchers aimed to assess vaccination rates and reasons for not being vaccinated among nearly 850,000 residents in more than 14,000 facilities. Racial disparities were compared within and between facilities.
Overall, vaccination rates slightly increased from 81.7% during the 2006-2007 influenza season to 82.8% during the 2008-2009 season. The increase was higher for blacks (from 75.4% to 77.8%) when compared with whites (from 82.6% to 83.5%). Yet, these rates were less than the 90% target for high-quality care, and blacks remained less likely to receive vaccination compared with whites, the researchers said.
When comparing facilities, vaccination rates were lowest in nursing homes with a higher proportion of blacks. Within the same facility, blacks were about 15% less likely to be vaccinated than whites.
Blacks were also more likely than whites to refuse vaccination (12.88% vs. 8.37% during 2008-2009 flu seasons). The researchers attributed this to their perceptions and beliefs about influenza vaccines. “Enhancing the communication between nursing home staff and black residents or providing education programs may change black residents’ knowledge regarding safety and effectiveness of flu vaccination, and increase their acceptance of flu vaccines,” Cai told Infectious Disease News. – by Ashley DeNyse
Disclosure: This work was supported in part by National Institute on Aging Grant No. P01AG027296 and in part by Agency for Healthcare Research and Quality (AHRQ) Grant No. HS018462.
In general, influenza immunization rates are unacceptably low among nursing home residents and even more so among nursing home care givers. Immunization of the care givers is even more important than immunization of residents in prevention and control of outbreaks. Among other reasons, many of the residents do not mount adequate antibody responses. I am convinced that the level of immunization in a facility is mainly related to the resources available and the commitment of the top management. Better funded immunization programs with dedicated infection control practitioners supported strongly by top management results in higher rates. My nursing home, a state VA home achieves a 95% immunization rate in residents. While socioeconomic, educational and cultural background of a given resident and their beliefs influence their willingness to accept immunization, more effort is required in those who refuse. Some of the steps that help are: 1) get a consent form for yearly immunization as a policy when residents are admitted, it is much more difficult later; 2) make an effort to reach responsible family members or those with a health care power of attorney for consent for those who are demented; 3) demonstrate to the residents that top management including the Medical and Nursing directors and their personal caregivers are getting immunized; 4) come back again and again to residents who refuse, using their favorite caregiver to influence them; 5) publicize , educate and publicize some more. I’d rather have any differential between races or any groups all be between 90% and 100% than have to worry about any group being below 90%.
– Donald Kaye, MD
Infectious Disease News Editorial Board member
Disclosure: Dr. Kaye reports no relevant financial disclosures.
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