Pneumococcal vaccination in nursing homes: does race make a difference?

Abstract

Objectives: Known disparities in pneumococcal vaccination in the community raise the question of whether disparities also exist in the nursing home setting, which is better controlled. This study used nationally representative nursing home data to compare black and white nursing home residents with respect to receiving, not receiving, or having an unknown PPV vaccination status, and to examine the interaction of race with various facility characteristics.

Design: Multinomial logistic regression was used to analyze a 2-year merged file (1997 and 1999) of the National Nursing Home Survey, a cross-sectional national probability sample of nursing homes and residents.

Setting and participants: Residents 65 years or older (n = 14,782) residing in nursing homes between July and December of 1997 or 1999.

Measurements: Record-based staff report of whether residents ever had a pneumococcal immunization (yes/no/unknown); race measured as black or white.

Results: Pneumococcal vaccination rates are lower for black nursing home residents than for white residents, as shown using a merged file of the 1997 and 1999 National Nursing Home Surveys. Participants include 14,303 randomly sampled residents 65 years or older. In this sample, 31% of black residents compared with 24% of white residents 65 years or older had never received pneumococcal vaccination (P < .01). Multivariate logistic regression confirmed that blacks were more likely to be unimmunized than whites (95% CIs), specifically in Medicaid-only facilities and dually certified Medicare and Medicaid facilities. Blacks also had higher odds of unknown vaccination status than whites in Medicaid-only facilities and lower odds of unknown status in government-owned facilities.

Conclusions: Results suggest that the racial difference in pneumococcal vaccination exists predominantly in certain facility types. In addition, facility-based interventions such as having an organized PPV immunization program or improving documentation of vaccination status can be effective in increasing vaccination rates for all races.