2193. Disparities in Hepatitis A Virus (HAV) Vaccination Coverage Among Adult Travelers to High-Risk Countries: The Role of Nativity and Race

Abstract

BackgroundWhile HAV vaccine is recommended for U.S. travelers, vaccination rates among foreign-born adults are lower than U.S.-born adults. Furthermore, some racial minority groups have low HAV vaccination coverage. We aimed to examine the relationship between nativity, race and their interaction as predictors of HAV vaccination status among adult travelers to high-risk countries (HRCs) through analysis of the National Health Interview Survey (NHIS), 2012–2015.MethodsThe study included 44,871 U.S. adult participants in the 2012–2015 NHIS who traveled to countries where HAV is endemic. The main outcome was self-reported HAV vaccination (≥2 doses). Complex survey methods were applied to all models to provide statistical estimates that are representative of U.S. adults. Multivariable logistic regression models adjusting for covariates were fit to examine the association between nativity, race, race-by-nativity (for interaction) and vaccination status.ResultsFor adult travelers to HRCs, the prevalence of HAV vaccination among foreign-born adults was lower than all adults 13.05% (95% CI; 12.11%, 14.00%) vs. 16.12% (95% CI; 15.60%, 16.64%). The adjusted odds ratio (AOR) of HAV vaccination was lower for foreign-born adults compared with U.S.-born AOR 0.86 (95% CI; 0.76, 0.98). For Hispanics, the AOR of HAV vaccination was 0.80 (95% CI; 0.70, 0.91) as compared with non-Hispanic-Whites. Furthermore, a significant qualitative interaction between nativity and race was found (P-value < 0.05). Among non-Hispanic Blacks, the adjusted odds of HAV vaccination for foreign-born adults were 1.35 (95% CI; 1.06, 1.72) times the odds for U.S.-born adults. In contrast, the AORs of vaccination of foreign-born vs. U.S.-born adults were 36% (95% CI; 17%, 51%) and 30% (95% CI; 12%, 44%), lower for Asians and Hispanics, respectively.ConclusionThe association between nativity and HAV vaccination status differs by race among travelers to HRCs, with U.S.-born non-Hispanic Black and foreign-born Asian and Hispanic adults having lower vaccination odds. Healthcare resources should be focused on these target populations to improve travel vaccination compliance. Nativity and race should be both assessed when analyzing and reporting HAV vaccination statistics for adult travelers.Disclosures V. Rustgi, Genfit: Grant Investigator and Investigator, Research support; Gilead: Speaker’s Bureau, Speaker honorarium; Abbvie: Speaker’s Bureau, Speaker honorarium.