Abstract
BackgroundInfluenza immunization is a highly effective method of reducing illness, hospitalization and mortality from this disease. However, influenza vaccination rates in the U.S. remain below public health targets and persistent structural inequities reduce the likelihood that Black, American Indian and Alaska Native, Latina/o, Asian groups, and populations of low socioeconomic status will receive the influenza vaccine.MethodsWe analyzed correlates of influenza vaccination rates using the 2019 Behavioral Risk Factor Surveillance System (BRFSS) in the year 2020. Our analysis compared influenza vaccination as the outcome of interest with the variables age, sex, race, education, income, geographic location, health insurance status, access to primary care, history of delaying care due to cost, and comorbidities such as: asthma, cardiovascular disease, hypertension, body mass index, cancer and diabetes.ResultsNon-Hispanic White (46.5%) and Asian (44.1%) participants are more likely to receive the influenza vaccine compared to Non-Hispanic Black (36.7%), Hispanic (33.9%), American Indian/Alaskan Native (36.6%), and Native Hawaiian/Other Pacific Islander (37.9%) participants. We found persistent structural inequities that predict influenza vaccination, within and across racial and ethnic groups, including not having health insurance [OR: 0.51 (0.47–0.55)], not having regular access to primary care [OR: 0.50 (0.48–0.52)], and the need to delay medical care due to cost [OR: 0.75 (0.71–0.79)].ConclusionAs COVID-19 vaccination efforts evolve, it is important for physicians and policymakers to identify the structural impediments to equitable U.S. influenza vaccination so that future vaccination campaigns are not impeded by these barriers to immunization.
Highlights
Influenza immunization is a highly effective method of reducing illness, hospitalization and mortality from this disease
Influenza immunization rates are below public health targets throughout the U.S population, and reflect persistent structural inequities that reduce the likelihood that Black, American Indian and Alaska Native, Latina/o, Asian groups, and populations of low socioeconomic status receive the influenza vaccine [2]
Health insurance status was determined from the question, “Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare, or Indian Health Service?” We used the following survey question to determine if someone had a primary care doctor, “Do you have one person you think of as your personal doctor or health care provider?” Delayed care due to cost was determined using the survey question, “Was there a time in the last 12 months when you needed to see a doctor but could not because of cost?” We examined geographic data by state divisions defined by the U.S Census
Summary
Influenza immunization is a highly effective method of reducing illness, hospitalization and mortality from this disease. Influenza vaccination rates in the U.S remain below public health targets and persistent structural inequities reduce the likelihood that Black, American Indian and Alaska Native, Latina/o, Asian groups, and populations of low socioeconomic status will receive the influenza vaccine. The CDC estimates that in the 2018–2019 United States influenza season, 35.5 million individuals were sick with influenza, resulting in 490,600 hospitalization and 34,200 deaths [1]. Influenza immunization rates are below public health targets throughout the U.S population, and reflect persistent structural inequities that reduce the likelihood that Black, American Indian and Alaska Native, Latina/o, Asian groups, and populations of low socioeconomic status receive the influenza vaccine [2]. The U.S does not currently provide federal funding for flu vaccination campaigns, some states offer programs for lower-income patients that cover access to care—the result is uneven access to healthcare, which is a structural issue in the U.S.
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