Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 1;6(1):87-91.
doi: 10.1001/jamacardio.2020.3978.

Sociodemographic Disparities in Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease in the United States

Gowtham R Grandhi  1 , Reed Mszar  2   3 , Farhaan Vahidy  4   5 , Javier Valero-Elizondo  6 , Ron Blankstein  7 , Michael J Blaha  8 , Salim S Virani  9   10 , Julia D Andrieni  11 , Saad B Omer  12   13   14   15 , Khurram Nasir  4   6   16
Affiliations

Sociodemographic Disparities in Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease in the United States

Gowtham R Grandhi et al. JAMA Cardiol. .

Abstract

Importance: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death and disability in the US and worldwide. Influenza vaccination has shown to decrease overall morbidity, mortality, severity of infection, and hospital readmissions among these individuals. However, national estimates of influenza vaccination among individuals with ASCVD in the US are not well studied.

Objective: To evaluate the prevalence of and sociodemographic disparities in influenza vaccination among a nationally representative sample of individuals with ASCVD.

Design, setting, and participants: Pooled Medical Expenditure Panel Survey data from 2008 to 2016 were used and included adults 40 years or older with ASCVD. Participants' ASCVD status was ascertained via self-report and/or International Classification of Diseases, Ninth Revision diagnosis of coronary heart disease, peripheral artery disease, and/or cerebrovascular disease. Analysis began April 2020.

Main outcomes and measures: Prevalence and characteristics of adults with ASCVD who lacked influenza vaccination during the past year. Covariates including age, sex, race/ethnicity, family income, insurance status, education level, and usual source of care were assessed.

Results: Of 131 881 adults, 19 793 (15.7%) had ASCVD, corresponding to 22.8 million US adults annually. A total of 7028 adults with ASCVD (32.7%), representing 7.4 million adults, lacked influenza vaccination. The highest odds of lacking vaccination were observed among individuals aged 40 to 64 years (odds ratio [OR], 2.32; 95% CI, 2.06-2.62), without a usual source of care (OR, 2.00; 95% CI, 1.71-2.33), without insurance (OR, 2.05; 95% CI, 1.63-2.58), with a lower education level (OR, 1. 25; 95% CI, 1.12-1.40), with a lower income level (OR, 1.14; 95% CI, 1.01-1.27), and of non-Hispanic Black race/ethnicity (OR, 1.24, 95% CI, 1.10-1.41). A stepwise increase was found in the prevalence and odds of lacking influenza vaccination among individuals with increase in high-risk characteristics. Overall, 1171 individuals (59.7%; 95% CI, 55.8%-63.5%) with 4 or more high-risk characteristics and ASCVD (representing 732 524 US adults annually) reported lack of influenza vaccination (OR, 6.06; 95% CI, 4.88-7.53).

Conclusion and relevance: Despite current recommendations, a large proportion of US adults with established ASCVD lack influenza vaccination, with several sociodemographic subgroups having greater risk. Focused public health initiatives are needed to increase access to influenza vaccinations for high-risk and underserved populations.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Blaha reports grants from National Institutes of Health, US Food and Drug Administration, American Heart Association, Aetna Foundation, and Amgen Foundation and personal fees from Sanofi, Regeneron, Novartis, Novo Nordisk, Bayer, Akcea Therapeutics, Zogenix, Tricida, Gilead Sciences, Aetna Foundation, and Amgen Foundation outside the submitted work. Dr Virani reports grant funding from the US Department of Veterans Affairs, World Heart Federation, and Tahir and Jooma Family; honoraria from American College of Cardiology; and is a steering committee member of the Patient and Provider Assessment of Lipid Management (PALM) registry at the Duke Clinical Research Institute (no financial remuneration). Dr Nasir is supported by the Jerold B. Katz Academy of Translational Research outside the submitted work and has served on the advisory board for Amgen, Novartis, and Esperion Therapeutics. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Weighted Proportions and Variations in Lacking Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease Stratified by the Cumulative Number of High-risk Sociodemographic Characteristics
A stepwise increase in the prevalence of lacking influenza vaccination with increasing high-risk characteristics is noted. Nearly 3 in 5 individuals with 4 or more high-risk characteristics reported lacking influenza vaccination. Error bars indicate 95% CIs. aHigh-risk characteristics include age 40 to 64 years, non-Hispanic Black race/ethnicity, low/poor family income, uninsured, lack of usual source of care, and high school education level or less.
Figure 2.
Figure 2.. National Estimates and ORs of Lacking Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease and High-risk Sociodemographic Characteristics
A stepwise increase in the odds of lacking influenza vaccination with increasing high-risk characteristics was noted. Individuals with 4 or more high-risk characteristics had nearly 6-fold higher odds of lacking influenza vaccination. aHigh-risk characteristics include age 40 to 64 years, non-Hispanic Black race/ethnicity, low/poor family income, uninsured, lack of usual source of care, and high school education level or less. bModel adjusted for sex, geographic region, cardiovascular risk factors, and comorbidities. Odds ratios (ORs) and 95% CIs are presented on a log scale.
See this image and copyright information in PMC

Comment in

References

    1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. ; American Heart Association Statistics Committee and Stroke Statistics Subcommittee . Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146-e603. doi:10.1161/CIR.0000000000000485 - DOI - PMC - PubMed
    1. Nguyen JL, Yang W, Ito K, Matte TD, Shaman J, Kinney PL. Seasonal influenza infections and cardiovascular disease mortality. JAMA Cardiol. 2016;1(3):274-281. doi:10.1001/jamacardio.2016.0433 - DOI - PMC - PubMed
    1. Thompson WW, Shay DK, Weintraub E, et al. . Influenza-associated hospitalizations in the United States. JAMA. 2004;292(11):1333-1340. doi:10.1001/jama.292.11.1333 - DOI - PubMed
    1. MacIntyre CR, Mahimbo A, Moa AM, Barnes M. Influenza vaccine as a coronary intervention for prevention of myocardial infarction. Heart. 2016;102(24):1953-1956. doi:10.1136/heartjnl-2016-309983 - DOI - PMC - PubMed
    1. Siscovick DS, Raghunathan TE, Lin D, et al. . Influenza vaccination and the risk of primary cardiac arrest. Am J Epidemiol. 2000;152(7):674-677. doi:10.1093/aje/152.7.674 - DOI - PubMed

MeSH terms

Substances