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
. 2023 Dec 14;5(4):otad078.
doi: 10.1093/crocol/otad078. eCollection 2023 Oct.

Racial, Ethnic, and Geographic Disparities in Immunization Rates Among Patients With Inflammatory Bowel Disease

Poonam Beniwal-Patel  1 , Gabrielle Waclawik  2 , Keely Browning  1 , Aijan Urmat  3 , Trevor L Schell  2 , Ryan Smith  4 , Antonio Huerta  5 , Lauren Hipp  6 , Sonya Dave  6 , Neemit Shah  7 , Kayla E Dillon  3 , Katelyn Reiter-Schreurs  3 , Rachel K Russ  3 , Miguel A Mailig  3 , Fauzia Osman  2 , Francis A Farraye  8 , Jennifer Weiss  4 , Mary S Hayney  3 , Freddy Caldera  4
Affiliations

Racial, Ethnic, and Geographic Disparities in Immunization Rates Among Patients With Inflammatory Bowel Disease

Poonam Beniwal-Patel et al. Crohns Colitis 360. .

Abstract

Background and aims: Racial and ethnic disparities exist in the treatment of IBD. These disparities exist in adult vaccine uptake among the general population and may extend to patients with IBD. The primary aim of this study was to determine whether racial, ethnic, or geographic disparities existed in influenza vaccine uptake among patients with IBD.

Methods: We performed a multicenter, retrospective cohort study evaluating adult vaccine uptake among patients with IBD seen at two tertiary referral centers between September 2019 and February 2020. The primary outcome was to determine if racial/ethnic and geographic disparities existed in influenza vaccine uptake for the two prior seasons. Our secondary outcomes were to determine if disparities existed for pneumococcal, zoster, or hepatitis B vaccines.

Results: Among the 2453 patients who met the inclusion criteria, most identified as non-Hispanic White (89.9%), were on immunosuppressive therapy (74.5%), and received the influenza vaccine in both seasons (56.0%). Older age (prevalence ratio (PR) 0.98; 95% confidence interval (95%CI) 0.98-0.99; P < .001) and non-Hispanic White patients (PR 0.76, 95%CI 0.59-0.98, P < 0.03) were significantly more likely to be immunized. Black patients (PR 1.37; 95%CI 1.18-1.59; P < .001) and those living in underserved geographic areas (PR 1.35; 95%CI 1.17-1.56; P < 0.001) were less likely to be immunized. Racial/ethnic and geographic disparities were identified for pneumococcal, zoster, and hepatitis B vaccine uptake.

Conclusions: Racial and ethnic vaccination uptake disparities exist among patients with IBD; patients from medically underserved areas are also vulnerable to these disparities Studies identifying patient, provider, and system-level opportunities to address these disparities are needed.

Keywords: inflammatory bowel diseases; influenza vaccine; pneumococcal vaccines; recombinant zoster vaccine.

PubMed Disclaimer

Conflict of interest statement

F.C. has received research support from Takeda Pharmaceuticals. He has been a consultant for Takeda, Arena Pharmaceuticals, GSK, and Celgene. F.A.F. is a consultant for AbbVie, BMS, Braintree Labs, Fresenius Kabi, GI Reviewers, GSK, IBD Educational Group, Iterative Health, Janssen, Pharmacosmos, Pfizer,Sebela and Viatris. He sits on a DSMB for Eli Lilly. M.S.H. is a consultant for GSK Vaccines and Seqirus and has received research support from Takeda Pharmaceuticals and Dynavax. P.B.P. has been a consultant for Takeda Pharmaceuticals. Guarantor of the article: F.C., D.O., M.S. F.C.—study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of manuscript. M.S.H—study concept and design, acquisition of data, analysis, and interpretation of data, drafting of the manuscript, and critical revision of manuscript. P.B.P.—study concept and design, acquisition of data, and interpretation of data, drafting of the manuscript, and critical revision of manuscript. G.W.—study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and critical revision of manuscript. F.A.F.—critical revision of manuscript. J.W.—study concept and design and critical revision of manuscript. K.B.—acquisition of data and critical revision of manuscript. A.U.—acquisition of data and critical revision of manuscript. T.L.S.—acquisition of data and critical revision of manuscript. R.S.—acquisition of data and critical revision of manuscript. A.H.—acquisition of data and critical revision of manuscript. L.H.—acquisition of data and critical revision of manuscript. K.E.D.—acquisition of data and critical revision of manuscript. S.D.—acquisition of data and critical revision of manuscript. N.S.—acquisition of data and critical revision of manuscript. K.R.S.—acquisition of data and critical revision of manuscript. R.K.R.—data analysis and critical revision of manuscript. M.A.M.—acquisition of data and critical revision of manuscript. F.O.—statistical analysis.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Wisconsin county map. Participants reside in the shaded counties.
Figure 2.
Figure 2.
Prevalence ratios (PR) for factors for receiving adult vaccines. A. Influenza vaccine in both 2017–2018 and 2018–19 seasons. Older age (PR 0.98; 95% confidence interval (95%CI) 0.98–0.99; P < .001), and non-Hispanic White patients (PR 0.76, 95% CI 0.59–0.98, P < .03) were significantly more likely to receive the influenza vaccine in both seasons. Male patients (PR 1.14; 95%CI 1.04–1.25; P = .004), Black patients (PR 1.37; 95%CI 1.18–1.59; P < 0.001) and those living in underserved geographic areas (PR 1.35; 95%CI 1.17–1.56; P < 0.001) were less likely to be immunized against influenza in both seasons. B. Pneumococcal vaccines (both pneumococcal conjugate 13-valent and pneumococcal polysaccharide 23-valent vaccines as recommended for immunosuppressed patients). Younger age PR 0.98; (95%CI 0.98–0.99; P < .001), and those who were not non-Hispanic White patients (PR 0.54; 95% CI 0.41–0.70; P < .001) were significantly more likely to have not completed the pneumococcal vaccine series. Hispanic patients were less likely to have completed the series compared to all others (PR 1.86; 95% CI 1.42–2.43; P < .001). Those living in rural areas were less likely to have completed the series (PR 1.18; 95% CI 1.02–1.37; P = .03). C. Hepatitis B vaccine. Unlike other vaccines, Black patients (PR 0.60; 95%CI 0.45–0.80; P < 0.001), patients on immunosuppressive therapy (PR 0.70; 95%CI 0.64–0.77; P < .001) and those living in an underserved area (PR 0.79; 95%CI 0.66–0.94; P = .009) were all associated with hepatitis B vaccine uptake. Patients who were older in age (PR 1.02; 95%CI 1.02–1.02; P < .001), non-Hispanic White (PR 1.19; 95%CI 1.00–1.40; P = .05) and rural-dwelling (PR 1.30; 95%CI 1.18–1.43; P < .001) were associated with less likely to have completed the hepatitis B vaccine series. D. Recombinant zoster vaccine for those aged 50 years and older. Black patients (PR 1.32; 95% 1.24–1.42; P < .001), patients on immunosuppressive therapy (PR 1.09; 95% CI 1.00–1.19; P = .05) and those living in an underserved area (PR 1.21; 95%CI 1.08–1.35; P = 0.001) were less likely to have received the recombinant zoster vaccine series.
See this image and copyright information in PMC

References

    1. Xu F, Dahlhamer JM, Terlizzi EP, Wheaton AG, Croft JB.. Receipt of preventive care services among US adults with inflammatory bowel disease, 2015-2016. Dig Dis Sci. 2019;64(7):1798-1808. - PMC - PubMed
    1. Dahlhamer JM, Zammitti EP, Ward BW, Wheaton AG, Croft JB.. Prevalence of inflammatory bowel disease among adults aged ≥18 years—United States, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(42):1166-1169. - PubMed
    1. Martinez ML, Coles S.. Addressing immunization health disparities. Prim Care. 2020;47(3):483-495. - PubMed
    1. Schell TL, Richard LJ, Tippins K, Russ RK, Hayney MS, Caldera F.. High but inequitable COVID-19 vaccine uptake among patients with inflammatory bowel disease. Clin Gastroenterol Hepatol. 2022;20(7):1606-1608.e2. - PMC - PubMed
    1. Sun Y, Monnat SM.. Rural-urban and within-rural differences in COVID-19 vaccination rates. J Rural Health. 2022;38(4):916-922. - PMC - PubMed

LinkOut - more resources