Structural inequities in seasonal influenza vaccination rates

Abstract

Background Influenza 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. Methods We 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. Results Non-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)]. Conclusion As 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.

COVID-19 vaccination coverage and intent among women aged 18–49 years by pregnancy status, United States, April–November 2021

“…Only 1 in 3 Black pregnant women had received ≥1 dose of a COVID-19 vaccine, and approximately 1 in 3 reported that they would probably/definitely NOT get a COVID-19 vaccine. Previous studies reported that several factors, including knowledge, attitudes, and beliefs about vaccines, mistrust resulting from past medical racism and experimentation, and barriers related to accessing vaccines and healthcare services contribute to lower vaccination rates in Black adults [39] , [40] , [41] . Household income below poverty, not having received other vaccines in the previous two years or a recommendation for COVID-19 vaccination from a healthcare provider, and not having any comorbidities were more commonly observed among unvaccinated women of reproductive age who were not sure about receiving a COVID-19 vaccine.…”

COVID-19 vaccination recommendations and practices for women of reproductive age, U.S. Physicians, Fall 2021

“…COVID-19 vaccines while pregnant or breastfeeding. Accessed June 8, 2022 , Goralnick et al, 2021 , Ratzan et al, 2021 , Razzaghi et al, 2020 , Yuen and Tarrant, 2020 , Brewer et al, 2021 , Huddleston et al, 2022 .…”

Understanding the Barriers and Attitudes toward Influenza Vaccine Uptake in the Adult General Population: A Rapid Review

“…The WHO does not provide a specific recommendation for influenza vaccination for the general population aged 18–64 years [ 7 ]. Only a limited number of studies are available investigating the attitudes towards influenza vaccination for all adults [ 10 ], though the need for attention to racial equity in influenza vaccination programs is well-documented [ 11 , 12 , 13 ]. This study identified differences in both attitude and vaccine coverage rates across these two sub-groups and encouraged future research on vaccine-seeking behaviors.…”