#72-S racial/ethnic disparities in influenza vaccination in elderly adults. The role of access to care.

摘要

PURPOSE: Although the benefits of influenza vaccination in high-risk adults are compelling, national influenza vaccination rates are low for Black and Hispanic adults 65 years and older. We analyzed data from the 1998 National Health Interview Survey (NHIS) to examine whether measures of access to care account for racial/ethnic disparities in influenza vaccination rates among elderly adults in the United States.METHODS: Indicators of access to care (predisposing, enabling, environmental/system and need) that were derived from Andersen's Behavioral Model were identified in the NHIS questionnaire. The relationship of these indicators to influenza vaccination and race/ethnicity was assessed with multiple logistic regression models using the SUDAAN program.RESULTS: Significant differences in vaccination were observed between Non-Hispanic (NH) Whites (66%) and both Hispanics (50%, p < 0.001) and NH Blacks (46%, p < 0.001). For Hispanics, the crude prevalence odds ratio (POR) for being unvaccinated (1.89, 95% CI: 1.5, 2.3) declined to 1.27 (0.9,1.7), after controlling for predisposing and enabling indicators, especially age, education, marital status, language proficiency, having a regular source of care and number of doctor visits. For NH Blacks, controlling for access to care indicators changed the POR from 2.24 (1.9, 2.7) to 1.93 (1.6, 2.4).CONCLUSION: Andersen's predisposing and enabling characteristics may explain some of the racial/ethnic disparity in influenza vaccination between Hispanic and non-Hispanic white elderly. To completely explain the possible reasons for the disparity in influenza vaccination among non-Hispanic blacks, other factors, such as patient attitudes and provider performance, should also be investigated.