Racial disparities exist in flu vaccination rates among nursing home residents
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A nationally representative study demonstrated a wide geographic variation in influenza vaccination for both non-Hispanic white and Hispanic short-stay and long-stay nursing home residents.
“Very few studies have examined racial/ethnic disparities in influenza vaccination between Hispanic and non-Hispanic white nursing home residents. The Hispanic population in the United States is projected to grow and represent approximately 20% of older adults by 2050,” Melissa R. Riester, PharmD, a postdoctoral research associate in health services, policy and practice at Brown University’s School of Public Health, told Healio. “So, it is highly important to quantify disparities in influenza vaccination between Hispanic and non-Hispanic white nursing home residents and identify where the largest disparities exist in order to inform interventions to reduce these disparities.”
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Riester and colleagues conducted a retrospective cohort study that included more than 14 million short-stay and long-stay U.S. nursing home residents over seven influenza seasons between Oct. 1, 2011, and March 31, 2018.
According to the study, the researchers used the Medicare Beneficiary Summary File to ascertain race/ethnicity and minimum data set assessments for influenza vaccination. They calculated age and sex-standardized percentage point (pp) differences in the proportions vaccinated between non-Hispanic white and Hispanic (any race) resident-seasons at both state and hospital referral region levels.
The final study cohort consisted of 7,442,241 short-stay resident-seasons (7,002,108 non-Hispanic white and 440,133 Hispanic) and 6,758,616 long-stay resident-seasons (6,335,373 non-Hispanic white and 423,243 Hispanic).
Overall, the study revealed wide geographic variation in influenza vaccination for both non-Hispanic white and Hispanic short-stay and long-stay nursing home residents between 2011 and 2018.
According to Riester, in the short-stay population — those who stayed less than 100 days in the same nursing home — 100% of states and 80% of hospital referral regions included in the geospatial analysis had standardized disparities, meaning that the proportion of non-Hispanic white resident-seasons vaccinated was greater than the proportion of Hispanic resident-seasons vaccinated.
Study data showed that the median standardized disparities in influenza vaccination were 4.3 pp (minimum: 0.3, maximum: 19.2) across 22 states and 2.8 pp (minimum: –3.6, maximum: 10.3) across 49 hospital referral regions.
In the long-stay population — those who stayed 100 consecutive days or more in any nursing home — 39% of states and 38% of hospital referral regions included in the geospatial analysis had standardized disparities. The study demonstrated that the median standardized differences were –0.1 pp (minimum: –4.1, maximum: 11.4) across 18 states and –1.8 pp (minimum: –6.5, maximum: 7.6) across 34 hospital referral regions.
“To reduce racial/ethnic disparities in influenza vaccination among nursing home residents, it may be most fruitful for future quality improvement interventions to target short-stay nursing home residents and geographic areas with the largest disparities,” Riester said. “Examining racial/ethnic disparities at smaller geographic levels (ie, at the hospital referral region-level) can allow for tailored localized interventions rather than applying a one-size-fits-all approach at a larger geographic level (ie, at the state or national level).”
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