Research article
The Role of Attitudes in Understanding Disparities in Adult Influenza Vaccination

https://doi.org/10.1016/j.amepre.2006.06.025Get rights and content

Background

Racial/ethnic disparities in influenza vaccine coverage of adults aged 65 years and older persist even after controlling for access, healthcare utilization, and socioeconomic status. Differences in attitudes toward vaccination may help explain these disparities. The purpose of this study was to describe patient characteristics and attitudes toward influenza vaccination among whites and African Americans aged 65 years and older, and to examine their effect on racial disparities in vaccination coverage.

Methods

A cross-sectional telephone survey of Medicare beneficiaries in five U.S. sites, sampled on race/ethnicity and ZIP code. Multivariate analysis controlling for demographics, healthcare utilization, and attitudes toward influenza vaccination was conducted in 2005 to assess racial disparities in vaccine coverage during the 2003–2004 season.

Results

The analysis included 1859 white and 1685 African-American respondents; 79% of whites versus 50% of African Americans reported influenza vaccination in the past year (p <0.00001). Both vaccinated and unvaccinated African Americans were significantly less likely than whites to report positive attitudes toward influenza vaccination. Even among respondents with provider recommendations, respondents with positive attitudes were more likely to be vaccinated than those with negative attitudes. After multivariate adjustment, African Americans had significantly lower odds of influenza vaccination than whites (odds ratio=0.55, 95% confidence interval=0.42–0.72).

Conclusions

A significant gap in vaccination coverage between African Americans and whites persisted even after controlling for specific respondent attitudes. Future research should focus on other factors such as vaccine-seeking behavior.

Introduction

In 2003, 69% of whites aged 65 years and older in the United States reported having received an influenza vaccine within the past 12 months, compared with 48% of African Americans.1 The persistence of racial disparities in adult vaccination, coupled with suboptimal influenza vaccine coverage among adults aged 65 and older, underscores the importance of identifying predictors of vaccination in this population.

Racial/ethnic differences in influenza vaccination rates persist after adjusting for provider visits,2, 3, 4, 5, 6, 7, 8 access to care,2, 6, 8 socioeconomic status,2, 4, 6, 7, 8 health insurance,2, 5, 6, 7, 8 perceived health,4, 5, 6, 8 chronic disease,2, 4, 6, 7, 8 and demographic characteristics.2, 3, 5, 6, 7, 8 It has been hypothesized that differences in attitude toward vaccination play an important role in these disparities.2, 4, 5, 6 While a number of studies have examined attitudes toward influenza vaccination,9, 10, 11, 12, 13, 14, 15, 16, 17 none included sufficient numbers of African Americans to compare attitudes of vaccinated and unvaccinated individuals across groups or to assess the extent to which disparities can be attributed to differences in attitude.

The purpose of this study was to examine attitudes toward influenza vaccination among unvaccinated and vaccinated respondents in a large, racially/ethnically diverse sample of older adults and to determine the effect of these attitudes on racial disparities in influenza vaccination coverage.

Section snippets

Study Design and Population

The Racial and Ethnic Adult Disparities in Immunization Initiative (READII) was a 3-year demonstration project funded by the Centers for Disease Control and Prevention and other federal partners at five U.S. sites: San Antonio TX, Chicago IL, Milwaukee WI, Rochester NY, and 19 counties in the Mississippi Delta region. Data-collection methods and eligibility criteria for READII have been previously described.3, 18 Briefly, Medicare beneficiaries aged ≥65 years residing in project areas were

Response Rate

To calculate response rate, it was assumed that telephone numbers with unknown responses (no answer, busy signal, answering machine) would produce eligible respondents proportionally to numbers with known responses. A total of 4988 interviews were completed among beneficiaries with available telephone numbers, for an overall response rate of 50.8%. Respondents missing the outcome of interest (current influenza vaccination status, n =139) were excluded from analysis. Since the analysis was

Discussion and Conclusions

This is the first published study to examine attitudes toward vaccination among vaccinated and unvaccinated respondents in a large, racially/ethnically diverse sample of older adults. African Americans in this sample were significantly less likely than whites to report positive attitudes toward influenza vaccination, both among unvaccinated and vaccinated respondents. The substantial gap in influenza vaccination coverage between older African-American and white Medicare beneficiaries remained

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