Minorities lag in flu-shot coverage for elderly

Dec 8, 2008 (CIDRAP News) – A report from the AARP Public Policy Institute says elderly African-Americans and Hispanics lag well behind elderly whites in influenza vaccination rates, even though the federal Medicare program fully covers the shots.

In 2006, 67% of whites aged 65 and older received flu shots, versus 47% of African-Americans and 45% of Hispanics in that age-group, according to the report, released last week. The figures were drawn from the Centers for Disease Control and Prevention's (CDC's) National Health Interview Survey.

All the rates were well below the federal government's Healthy People 2010 goal of 90% flu immunization coverage among the elderly, notes the report. It was prepared by the policy research arm of AARP, a nonprofit, nonpartisan organization for people aged 50 and older.

Citing a 2007 study published in Preventive Medicine, the report says that eliminating racial and ethnic disparities in flu vaccine coverage would prevent an estimated 1,880 minority deaths every year. (The 2007 study was based on slightly different immunization rate estimates than those from the National Health Interview Survey.)

The AARP also says that the two minority groups lag well behind whites in pneumococcal pneumonia vaccination coverage in the elderly, with rates of 36% for African-Americans, 33% for Hispanics, and 62% for whites.

The report says researchers have cited several contributors to the low flu and pneumonia immunization rates among minority groups, including:

  • Individuals' lack of awareness of the need for the vaccinations
  • Individuals' fear that the vaccines will cause "severe illness"
  • Healthcare providers' underestimation of the safety and efficacy of the vaccines
  • Providers' lack of familiarity with age-based immunization recommendations
  • Providers' failure to recommend the shots to older adults and to use standing orders to promote them

In an AARP news release, Dr. Jeanne Santoli of the CDC commented, "We know that minority groups often experience more medical consequences from influenza. One example is [that] Hispanics 65 years of age and older often suffer from more chronic health conditions such as diabetes and heart disease, which makes them more susceptible to flu-related complications that can lead to hospitalization and even death."

The AARP report also reviews various federal, state, and private-sector efforts to improve immunization rates among minorities. One program that achieved some success was the CDC's Racial and Ethnic Adult Disparities in Immunization Initiative, or READII, a 3-year program that was launched in 2002 to address racial and ethnic differences in immunizations rates for Medicare recipients at five sites around the country.

Overall, the program decreased gaps in flu and pneumonia immunization at all five sites, but the difference was not statistically significant, the report says. However, certain initiatives that targeted providers were more successful. For example, clinics in Rochester, N.Y., monitored seniors, provided telephone and mail reminders to patients, and notified providers about unvaccinated patients.

Over 2 years, these efforts led to "substantial increases" in flu vaccination across racial groups and raised pneumococcal vaccine coverage to 80%.

"READII showed that offering vaccines directly and making patient and provider reminders routine dramatically improved vaccine usage in minority populations," the report states. However, it notes that the Rochester program relied on outside funding and therefore may be hard to duplicate elsewhere.

The report says that other programs and practices that may help boost immunization coverage among minorities include vaccine clinics at or near polling places, using pharmacists as immunizers, and using flu-immunization coverage among Medicare enrollees as a quality measure for healthcare institutions.

It also suggests that elderly people who have been vaccinated against flu before are much more likely to do it again.

"A 2006 study showed that, when vaccines are offered to all person 65 years or older in a clinical setting in the same manner, the single most important factor determining flu vaccination is past receipt of flu vaccine," the report states. "In the 2006 study, age, gender, education, and race were all inconsequential if a person received a vaccine the prior year. This is encouraging in the face of disparities because it implies that vaccination efforts will become easier to sustain as they progress and people's habits change."

The report concludes, "The challenge is twofold: educating patients about the benefits of vaccination so they can engage in responsible disease prevention and aligning providers and health systems to prioritize adult vaccination. The success of targeted short-term efforts depends on broader sustained commitment to vaccination to increase immunization among all populations."

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