Geographic Variation in Influenza Vaccination Disparities Between Hispanic and Non-Hispanic White US Nursing Home Residents

Melissa R Riester; Anthony I Roberts; Joe B B Silva; Chanelle J Howe; Barbara H Bardenheier; Robertus van Aalst; Matthew M Loiacono; Andrew R Zullo

doi:10.1093/ofid/ofac634

Geographic Variation in Influenza Vaccination Disparities Between Hispanic and Non-Hispanic White US Nursing Home Residents

Open Forum Infect Dis. 2022 Nov 24;9(12):ofac634. doi: 10.1093/ofid/ofac634. eCollection 2022 Dec.

Authors

Melissa R Riester^{1

2}, Anthony I Roberts^{1

2}, Joe B B Silva^{1

2}, Chanelle J Howe^{3

4}, Barbara H Bardenheier^{1

2

3

5}, Robertus van Aalst^{1

6

7}, Matthew M Loiacono⁸, Andrew R Zullo^{1

2

3

9}

Affiliations

¹ Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
² Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA.
³ Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.
⁴ Center for Epidemiologic Research, Brown University, Providence, Rhode Island, USA.
⁵ Westat LLC, Rockville, Maryland, USA.
⁶ Department of Modelling, Epidemiology, and Data Science, Global Medical Affairs, Sanofi, Lyon, France.
⁷ Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁸ Global Medical Evidence Generation, Sanofi, Swiftwater, Pennsylvania, USA.
⁹ Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA.

Abstract

Background: Disparities in influenza vaccination exist between Hispanic and non-Hispanic White US nursing home (NH) residents, but the geographic areas with the largest disparities remain unknown. We examined how these racial/ethnic disparities differ across states and hospital referral regions (HRRs).

Methods: This retrospective cohort study included >14 million short-stay and long-stay US NH resident-seasons over 7 influenza seasons from October 1, 2011, to March 31, 2018, where residents could contribute to 1 or more seasons. Residents were aged ≥65 years and enrolled in Medicare fee-for-service. We used the Medicare Beneficiary Summary File to ascertain race/ethnicity and Minimum Data Set assessments for influenza vaccination. We calculated age- and sex-standardized percentage point (pp) differences in the proportions vaccinated between non-Hispanic White and Hispanic (any race) resident-seasons. Positive pp differences were considered disparities, where the proportion of non-Hispanic White residents vaccinated was greater than the proportion of Hispanic residents vaccinated. States and HRRs with ≥100 resident-seasons per age-sex stratum per racial/ethnic group were included in analyses.

Results: Among 7 442 241 short-stay resident-seasons (94.1% non-Hispanic White, 5.9% Hispanic), the median standardized disparities in influenza vaccination were 4.3 pp (minimum, maximum: 0.3, 19.2; n = 22 states) and 2.8 pp (minimum, maximum: -3.6, 10.3; n = 49 HRRs). Among 6 758 616 long-stay resident-seasons (93.7% non-Hispanic White, 6.5% Hispanic), the median standardized differences were -0.1 pp (minimum, maximum: -4.1, 11.4; n = 18 states) and -1.8 pp (minimum, maximum: -6.5, 7.6; n = 34 HRRs).

Conclusions: Wide geographic variation in influenza vaccination disparities existed across US states and HRRs. Localized interventions targeted toward areas with high disparities may be a more effective strategy to promote health equity than one-size-fits-all national interventions.

Keywords: ethnic groups; health care disparities; influenza; nursing homes; vaccines.