Vital Signs: Influenza Hospitalizations and Vaccination Coverage by Race and Ethnicity-United States, 2009-10 Through 2021-22 Influenza Seasons

Abstract

Introduction: CDC estimates that influenza resulted in 9-41 million illnesses, 140,000-710,000 hospitalizations, and 12,000-52,000 deaths annually during 2010-2020. Persons from some racial and ethnic minority groups have historically experienced higher rates of severe influenza and had lower influenza vaccination coverage compared with non-Hispanic White (White) persons. This report examines influenza hospitalization and vaccination rates by race and ethnicity during a 12-13-year period (through the 2021-22 influenza season).

Methods: Data from population-based surveillance for laboratory-confirmed influenza-associated hospitalizations in selected states participating in the Influenza-Associated Hospitalization Surveillance Network (FluSurv-NET) from the 2009-10 through 2021-22 influenza seasons (excluding 2020-21) and influenza vaccination coverage data from the Behavioral Risk Factor Surveillance System (BRFSS) from the 2010-11 through 2021-22 influenza seasons were analyzed by race and ethnicity.

Results: From 2009-10 through 2021-22, age-adjusted influenza hospitalization rates (hospitalizations per 100,000 population) were higher among non-Hispanic Black (Black) (rate ratio [RR] = 1.8), American Indian or Alaska Native (AI/AN; RR = 1.3), and Hispanic (RR = 1.2) adults, compared with the rate among White adults. During the 2021-22 season, influenza vaccination coverage was lower among Hispanic (37.9%), AI/AN (40.9%), Black (42.0%), and other/multiple race (42.6%) adults compared with that among White (53.9%) and non-Hispanic Asian (Asian) (54.2%) adults; coverage has been consistently higher among White and Asian adults compared with that among Black and Hispanic adults since the 2010-11 season. The disparity in vaccination coverage by race and ethnicity was present among those who reported having medical insurance, a personal health care provider, and a routine medical checkup in the past year.

Conclusions and implications for public health practice: Racial and ethnic disparities in influenza disease severity and influenza vaccination coverage persist. Health care providers should assess patient vaccination status at all medical visits and offer (or provide a referral for) all recommended vaccines. Tailored programmatic efforts to provide influenza vaccination through nontraditional settings, along with national and community-level efforts to improve awareness of the importance of influenza vaccination in preventing illness, hospitalization, and death among racial and ethnic minority communities might help address health care access barriers and improve vaccine confidence, leading to decreases in disparities in influenza vaccination coverage and disease severity.

FIGURE 1

Age-adjusted Influenza-associated hospitalization rates among adults aged ≥18 years, by race and ethnicity — Influenza-Associated Hospitalization Surveillance Network, United States, 2009–10 through 2021–22 Abbreviations: AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander; NH = non-Hispanic. * Hospitalizations per 100,000 population. ^† Excluding 2020–21 season.

FIGURE 2

Age-adjusted Influenza-associated hospitalization rates among adults, by race and ethnicity and influenza season — Influenza-Associated Hospitalization Surveillance Network, United States, 2009–10 through 2019–20 and 2021–22 Abbreviations: AI/AN = American Indian or Alaska Native; API = Asian or Pacific Islander; NH = non-Hispanic. * Data for 2020–21 season are not included.

FIGURE 3

Influenza vaccination coverage among adults aged ≥18 years, by race and ethnicity and influenza season — Behavioral Risk Factor Surveillance System, United States, 2010–11 through 2021–22 Abbreviations: AI/AN = American Indian or Alaska Native; NH = non-Hispanic.