Racial and Ethnic Disparities in Adult Vaccination: A Review of the State of Evidence

Abstract

Background: Adult vaccination coverage remains low in the United States, particularly among racial and ethnic minority populations.

Objective: To conduct a comprehensive literature review of research studies assessing racial and ethnic disparities in adult vaccination.

Search methods: We conducted a search of PubMed, Cochrane Library, ClinicalTrials.gov, and reference lists of relevant articles.

Selection criteria: Research studies were eligible for inclusion if they met the following criteria: (1) study based in the United States, (2) evaluated receipt of routine immunizations in adult populations, (3) used within-study comparison of race/ethnic groups, and (4) eligible for at least one author-defined PICO (patient, intervention, comparison, and outcome) question.

Data collection and analysis: Preliminary abstract review was conducted by two authors. Following complete abstraction of articles using a standardized template, abstraction notes and determinations were reviewed by all authors; disagreements regarding article inclusion/exclusion were resolved by majority rule. The Social Ecological Model framework was used to complete a narrative review of observational studies to summarize factors associated with disparities; a systematic review was used to evaluate eligible intervention studies.

Results: Ninety-five studies were included in the final analysis and summarized qualitatively within two main topic areas: (1) factors associated with documented racial-ethnic disparities in adult vaccination and (2) interventions aimed to reduce disparities or to improve vaccination coverage among racial-ethnic minority groups. Of the 12 included intervention studies, only 3 studies provided direct evidence and were of Level II, fair quality; the remaining 9 studies met the criteria for indirect evidence (Level I or II, fair or poor quality).

Conclusions: A considerable amount of observational research evaluating factors associated with racial and ethnic disparities in adult vaccination is available. However, intervention studies aimed at reducing these disparities are limited, are of poor quality, and insufficiently address known reasons for low vaccination uptake among racial and ethnic minority adults.

Keywords: adult immunization; health equity; health inequality; racial and ethnic disparities; vaccine.

FIG. 1.

Flow chart of included and excluded observational and intervention studies.

FIG. 2.

Reasons and associations for racial and ethnic disparities in adult vaccination by SEM level. SEM, Social Ecological Model.