Do vaccination strategies implemented by nursing homes narrow the racial gap in receipt of influenza vaccination in the United States?

Abstract

Objectives: To determine whether the racial inequity between African Americans and Caucasians in receipt of influenza vaccine is narrower in residents of nursing homes with facility-wide vaccination strategies than in residents of facilities without vaccination strategies.

Design: Secondary data analysis using the National Nursing Home Survey 2004, a nationally representative survey.

Setting: One thousand one hundred seventy-four participating nursing homes sampled systematically with probability proportional to bed size.

Participants: Thirteen thousand five hundred seven randomly sampled residents of nursing homes between August and December 2004.

Measurements: Receipt of influenza vaccine within the last year. Logistic regression was used to examine the relationship between facility-level influenza immunization strategy and racial inequity in receipt of vaccination, adjusted for characteristics at the resident, facility, state, and regional levels.

Results: Overall in the United States, vaccination coverage was higher for Caucasian and African-American residents; the racial vaccination gaps were smaller (<6 percentage points) and nonsignificant in residents of homes with standing orders for influenza vaccinations (P=.14), verbal consent allowed for vaccinations(P=.39), and routine review of facility-wide vaccination rates (P=.61) than for residents of homes without these strategies. The racial vaccination gap in residents of homes without these strategies were two to three times as high (P=.009, P=.002, and P=.002, respectively).

Conclusion: The presence of several immunization strategies in nursing homes is associated with higher vaccination coverage for Caucasian and African-American residents, narrowing the national vaccination racial gap.