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. 2022 Apr 26;40(19):2696-2704.
doi: 10.1016/j.vaccine.2022.03.058. Epub 2022 Mar 29.

Trends and disparities in the utilization of influenza vaccines among commercially insured US adults during the COVID-19 pandemic

Kun Li  1 , Tianzhou Yu  2 , Seth A Seabury  3 , Avi Dor  4
Affiliations

Trends and disparities in the utilization of influenza vaccines among commercially insured US adults during the COVID-19 pandemic

Kun Li et al. Vaccine. .

Abstract

Objectives: Little is known about how the coronavirus disease 2019 (COVID-19) pandemic affected influenza vaccine utilization and disparities. We sought to estimate changes in the likelihood of receiving an influenza vaccine across different demographic subgroups during the COVID-19 pandemic.

Methods: In this cohort study, we analyzed influenza vaccine uptake from 2019 to 2020 using Optum commercial insurance claims data. Eligible individuals were aged 18 or above in 2018 and continuously enrolled from 08/01/2018 through 12/31/2020. Multivariable logistic regressions were fitted for the individual-level influenza vaccine uptake. Adjusting for demographic factors and medical histories, we estimated probabilities of receiving influenza vaccines before and after the COVID-19 pandemic across demographic subgroups.

Results: From August to December 2019, unadjusted influenza vaccination rate was 42.3%, while in the same period of 2020, the vaccination rate increased to 45.9%. Females had a higher vaccination rate in 2019 (OR: 1.16, 95% CI 1.15-1.16), but the increase was larger for males. Blacks and Hispanics had lower vaccination rates relative to whites in both flu seasons. Hispanics showed a greater increase in vaccination rate, increasing by 7.8 percentage points (p < .001) compared to 4.4 (p < .001) for whites. The vaccination rate for Blacks increased by 5.2 percentage points (p < .001). All income groups experienced vaccination improvements, but poorer individuals had lower vaccination rates in both seasons. The most profound disparities occurred when educational cohort were considered. The vaccination rate increased among college-educated enrollees by 8.8 percentage points (p < .001) during the pandemic compared to an increase of 2.8 percentage points (p < .001) for enrollees with less than a 12th grade education. Past influenza infections or vaccination increased the likelihood of vaccination (p < .001).

Conclusions: The COVID-19 pandemic was associated with increased influenza vaccine utilization. Disparities persisted but narrowed with respect to gender and race but worsened with respect to income and educational attainment.

Keywords: COVID-19; Health Disparity; Influenza; Vaccination.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Patient Selection and Attrition.
Fig. 2
Fig. 2
Percent Change of Weekly Influenza Vaccine Uptake, 2019 vs 2020. Percent change of weekly influenza vaccine uptake after August 1, 2020, compared with same weeks in 2019. Methodology details are presented in Appendix B.
Fig. 3
Fig. 3
Predicted Probabilities of Receiving Influenza Vaccines by Sample Characteristics and Flu Season. *Significance at 0.05 level. Predicted probabilities of receiving influenza vaccines in the 2019–20 season (blue dots) and the 2020–21 season (orange dots), predicted from the fitted logistic regression models, holding other predictors constant at their analytical sample mean. Specifications, estimates, 95% confidence intervals, and p-values are in Appendix C. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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