Do Vaccination Strategies Implemented by Nursing Homes Narrow the Racial Gap in Receipt of Influenza Vaccination in the United States?

• Authors: Barbara Bardenheier, Centers for Disease Control and Prevention; Abigail Shefer, Centers for Disease Control and Prevention; Faruque Ahmed, Centers for Disease Control and Prevention; Robin Remsburg, George Mason University; Carol J Hogue, Emory University; Stefan Gravenstein, Brown University
• Journal Title: Journal of the American Geriatrics Society
• Volume: Volume 59, Number 4
• Publisher: Wiley: 12 months | 2011-04-01, Pages 687-693
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/j.1532-5415.2011.03332.x
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology; Health Sciences, Health Care Management
• Keywords: Science & Technology; Life Sciences & Biomedicine; Geriatrics & Gerontology; Gerontology; vaccination; nursing home; racial disparity; influenza; NNHS; QUALITY; DISPARITIES; RESIDENTS

Abstract

OBJECTIVES: To determine whether the racial inequity between African Americans and Caucasians in receipt of influenza vaccine is narrower in residents of nursing homes with facility-wide vaccination strategies than in residents of facilities without vaccination strategies. DESIGN: Secondary data analysis using the National Nursing Home Survey 2004, a nationally representative survey. SETTING: One thousand one hundred seventy-four participating nursing homes sampled systematically with probability proportional to bed size. PARTICIPANTS: Thirteen thousand five hundred seven randomly sampled residents of nursing homes between August and December 2004. MEASUREMENTS: Receipt of influenza vaccine within the last year. Logistic regression was used to examine the relationship between facility-level influenza immunization strategy and racial inequity in receipt of vaccination, adjusted for characteristics at the resident, facility, state, and regional levels. RESULTS: Overall in the United States, vaccination coverage was higher for Caucasian and African-American residents; the racial vaccination gaps were smaller (<6 percentage points) and nonsignificant in residents of homes with standing orders for influenza vaccinations (P=.14), verbal consent allowed for vaccinations(P=.39), and routine review of facility-wide vaccination rates (P=.61) than for residents of homes without these strategies. The racial vaccination gap in residents of homes without these strategies were two to three times as high (P=.009, P=.002, and P=.002, respectively). CONCLUSION: The presence of several immunization strategies in nursing homes is associated with higher vaccination coverage for Caucasian and African-American residents, narrowing the national vaccination racial gap.