Disparities in influenza vaccine coverage in the United States, 2008

Abstract

Objectives: To determine the distribution of influenza vaccine coverage in the United States in 2008.

Design: Cross-sectional analysis.

Setting: The 2008 Behavioral Risk Factor Surveillance Survey, which employs random-digit dialing to interview noninstitutionalized adults in the United States and territories.

Participants: Two hundred forty-nine thousand seven hundred twenty-three persons aged 50 and older.

Measurements: Participants were asked whether they had had an influenza vaccination during the previous 12 months.

Results: In 2008, 42.0% of adults aged 50 to 64 and 69.5% of adults aged 65 and older reported receiving an influenza vaccination in the past 12 months. Vaccine coverage generally increased with advancing age (P<.001), higher levels of education (P<.001) and total household income (P<.001), and greater morbidity (P<.001). In participants aged 50 to 64, vaccine prevalence was lower in men (39.9%) than in women (44.1%; P<.001), although no significant differences were observed in older adults. Within each 5-year interval of age, non-Hispanic blacks and Hispanics had significantly lower vaccine prevalence than non-Hispanic whites (P<.001 for all comparisons). For participants aged 65 and older, non-Hispanic blacks and Hispanics were 56% (adjusted prevalence ratio (PR)=1.56, 95% confidence interval (CI)=1.48, 1.64) and 44% (adjusted PR=1.44, 95% CI=1.35, 1.54) more likely, respectively, to be unvaccinated than non-Hispanic whites, adjusting for age and sex. Racial and ethnic disparities in vaccine coverage narrowed with increasing number of diseases, although these disparities remained significant in older adults with two or more diseases (P<.05).

Conclusion: There were large disparities in influenza vaccine coverage in 2008, particularly across race and ethnicity and socioeconomic position. Accordingly, more targeted interventions are needed to improve vaccine delivery to disadvantaged segments of the U.S. population.

Figure 1. Vaccine coverage by race/ethnicity and number of diseases in adults ages 50–64 years (A) and ≥65 years (B)

Note: Diseases included asthma, coronary heart disease, diabetes, and stroke * p<0.05 for comparison with non-Hispanic whites ** p<0.001 for comparison with non-Hispanic whites