Racial/Ethnic Differences in Receipt of Influenza and Pneumococcal Vaccination among Long‐Stay Nursing Home Residents

Travers, Jasmine; Dick, Andrew W.

doi:10.1111/1475-6773.12759

Cited by 17 publications

(13 citation statements)

References 41 publications

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“…17 Similar to prior research, we categorized proportions of Black residents in nursing homes as none, <20%, 20%e49.9%, !50%, or not reported. 3,18 We combined the 50%e79.9% group (n ¼ 558), 80%e 94.9% group (n ¼ 109), and the 95%e100% group (n ¼ 14) to provide sufficient power. Not reported denotes nursing homes that had missing data for their percentage of racial/ethnic minorities.…”

Section: Methodsmentioning

confidence: 99%

Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents

Travers

Agarwal

Estrada

et al. 2021

Journal of the American Medical Directors Association

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Objective COVID-19 has disproportionately impacted nursing homes (NHs) with large shares of Black residents. We examined the associations between the proportion of Black residents in NHs and COVID-19 infections and deaths, accounting for structural bias (operationalized as county-level factors) and stratifying by urbanicity/rurality. Design This was a cross-sectional observational cohort study using publicly available data from the LTCfocus, Centers for Disease Control and Prevention (CDC) Long-Term Care Facility COVID-19 Module, and the NYTimes county-level COVID-19 database. Four multivariable linear regression models omitting and including facility characteristics, COVID-19 burden, and county-level fixed effects were estimated. Setting and Participants: 11,587 US NHs that reported data on COVID-19 to the CDC and had data in LTCfocus and NYTimes from January 20 th , 2020 through July 19 th , 2020. Measures Proportion of Black residents in NHs (exposure); COVID-19 infections and deaths (main outcomes). Results The proportion of Black residents in NHs were as follows: none= 3,639 (31.4%), <20%= 1,020 (8.8%), 20-49.9%= 1,586 (13.7%), ≥50= 681 (5.9%), not reported= 4,661 (40.2%). NHs with any Black residents showed significantly more COVID-19 infections and deaths than NHs with no Black residents. There were 13.6 percentage points more infections and 3.5 percentage points more deaths in NHs with ≥50% Black residents than in NHs with no Black residents (p<.001). While facility characteristics explained some of the differences found in multivariable analyses, county-level factors and rurality explained more of the differences. Conclusions and Implications It is likely that attributes of place, such as resources, services, and providers, important to equitable care and health outcomes are not readily available to counties where NHs have greater proportions of Black residents. Structural bias may underlie these inequities. It is imperative that support be provided to NHs that serve greater proportions of Black residents while considering the rurality of the NH setting.

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Section: Methodsmentioning

confidence: 99%

Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents

Travers

Agarwal

Estrada

et al. 2021

Journal of the American Medical Directors Association

Self Cite

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“…My study suggests there is something specific about heterosexuality in combination with black identity is driving lower vaccination. As previously discussed, black adults face many barriers to vaccinate against influenza, such as not being offered the vaccine (Travers et al, ( 2018 ) denying the vaccine due to mistrust and lower vaccine literacy (Chen et al, 2007 ; Quinn et al, 2016 ; Quinn et al, 2017 ; Quinn, 2018 ), and, in general, a lack of access to healthcare and quality healthcare due to racism (Phelan & Link, 2015 ). Research has also found higher proportions of racial consciousness led to lower vaccination rates among black adults (Quinn et al, 2017 ) and general worry about adverse effects of the vaccine (Freimuth et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…As mentioned above, vaccination is the most effective strategy to reduce influenza death and illness, with vaccination being recommended for anyone over 6 months of age to prevent disease among individuals and their communities (CDC, 2021a(CDC, , 2021b(CDC, , 2021cUS Department of Health & Human Services, 2022). Studies often focus on vaccination among elderly and/ or high-risk individuals, rather than larger population-based samples (e.g., Travers et al, 2018). Scholarship using National Health Interview Survey (NHIS) found in 2015-2016, influenza vaccination had increased among adults aged 18-64 (at 1.5%, on average, each year) compared to 2010-2011 (Tian et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Intersectional Immunity? Examining How Race/Ethnicity and Sexual Orientation Combine to Shape Influenza Vaccination Among US Adults

Wilkins

2022

Popul Res Policy Rev

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Influenza vaccination is a critical preventive healthcare behavior designed to prevent spread of seasonal flu. This paper contributes to existing scholarship by applying an intersectional perspective to examine how influenza vaccination differs across specific intersections of racial/ethnic and sexual identity. Drawing on aggregated state-level data from Behavioral Risk Factor Surveillance System (BRFSS) from 2011 to 2020, I examine how flu vaccination differs across 18 racial/ethnic-by-sexual orientation groups (N = 1,986,432). Findings from descriptive analyses and logistic regression modeling demonstrate three key findings. First, it corroborates previous studies of vaccination, finding lower rates of flu vaccination among black adults relative to whites; gays/lesbians vaccinate at higher rates than heterosexuals and bisexuals, with bisexuals reporting lower vaccination relative to both heterosexuals and gays/lesbians. Second, it demonstrates how sexual orientation complicates established patterns between race/ethnicity and vaccination (e.g., influenza vaccination is more racially stratified among heterosexuals, with patterns more variable among gays/lesbians) and how race/ethnicity complicates previous patterns of vaccination by sexual orientation (e.g., Asian bisexuals vaccinate more than both heterosexuals). Third, findings pinpoint identities (e.g., black heterosexuals relative to their white peers and white bisexuals relative to their gay/lesbian peers) most in need of influenza vaccination outreach efforts. Implications for findings suggest that heterosexuals, especially black, may be less likely to vaccinate against influenza thus may need more encouragement from clinicians to vaccinate. Additionally, influenza vaccination should be free for all persons to lessen the barrier of access for this preventative healthcare.

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“…While it is often difficult to assess the complex psychological, sociological, and demographic factors (Travers, Dick, & Stone, 2018 ) associated with healthcare choices, and in particular, the choice to get vaccinated, the results of this work help shine a light on some important points of engagement policymakers have with individuals who have not vaccinated in the past. For example, if the problem is that individuals who are more risk-tolerant are also more likely to refuse the seasonal influenza vaccination, which is consistent with my findings, targeted campaigns for this group may tip the balance in favour of getting protection.…”

Section: Discussionmentioning

confidence: 99%

Risky behaviour and non-vaccination

Neymotin

2021

J Bioecon

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Widespread vaccination acceptance is of critical import to society dealing with the continuing aftermath of the COVID-19 pandemic. The risky behaviours that predict whether individuals vaccinate for seasonal influenza can help policymakers fashion plans to improve vaccination rates and more reliably establish herd immunity. To this end, Canadian Community Health Survey (CCHS) data were employed to determine how an individual’s choice to engage in various risky behaviours relates with the likelihood that the same individual gets the seasonal influenza vaccine. Controls were included for demographic, geographic, and health insurance factors. In addition to controlling for these factors, regressions were further stratified based upon gender, the presence of children in the home, and age. I found that excess sun exposure, poor oral hygiene, smoking, and unhealthy diet choices correlated with reduced vaccination probability—both over the subsequent year and for that individual’s lifetime. These results have important implications for properly targeting individuals for widespread vaccinations.

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Racial/Ethnic Differences in Receipt of Influenza and Pneumococcal Vaccination among Long‐Stay Nursing Home Residents

Abstract: Racial/ethnic differences remain despite policy changes. Focused strategies aimed at NH personnel and racially segregated NHs are critical to improving vaccination delivery and eliminating disparities in care.

Cited by 17 publications

References 41 publications

Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents

Assessment of Coronavirus Disease 2019 Infection and Mortality Rates Among Nursing Homes With Different Proportions of Black Residents

Intersectional Immunity? Examining How Race/Ethnicity and Sexual Orientation Combine to Shape Influenza Vaccination Among US Adults

Risky behaviour and non-vaccination

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