Influenza and pneumococcal vaccination of adults aged ≥65:: Racial/ethnic differences

Background: Influenza and pneumococcal polysaccharide vaccination (PPV) rates among persons aged >= 65 years are significantly below national objectives of 90%, particularly among blacks and Hispanics. This study of the 2002-2003 influenza season examines factors that may be associated with low coverage. Methods: A national sample of 1839 community-dwelling adults aged >= 65 years was surveyed by telephone during January-May 2003. Outcomes analyzed in 2004-2005 included self-reported influenza vaccination and PPV; place of vaccination; and among the unvaccinated, main reasons for nonvaccination, awareness of vaccination, and receipt of provider recommendation for vaccination. Results: Influenza vaccine coverage was 67.8%, and PPV coverage was 60%. Coverage among blacks and Hispanics was >= 15 percentage points below that of whites. Half (52%) of persons who had not received PPV were aware it was recommended for persons their age, and < 10% had received a recent physician recommendation for PPV. Concern about side effects and not thinking that they needed the vaccine were the most frequently cited reasons for not receiving an influenza vaccination. In each racial/ethnic group, prevalence of potential missed opportunities (recent doctor visit, but no vaccine recommendation from provider and no influenza vaccination) was higher than prevalence of potential vaccine refusal (recent doctor visit and vaccine recommendation from provider, but no vaccine): blacks, 26.9% versus 7.9%; Hispanics, 19.9% versus 12.1%; and white non-Hispanics, 16.2% versus 6.1%. Conclusions: Improved adherence to vaccination guidelines by healthcare providers could substantially raise coverage in all racial/ethnic groups. Multiple factors contribute to racial/ethnic disparities, and their relative contributions should be further quantified.