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Author Notes:

Barbara Bardenheier, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS E-52, Atlanta, GA 30333. bfb7@cdc.gov.

Barbara Bardenheier: study concept and design (specifically worked on the facility vaccination policy questions on the survey), data analysis and interpretation, and preparation of the manuscript; Abigail Shefer: study design, data interpretation, and critical review of the manuscript; Faruque Ahmed: analysis and interpretation of data, revising it critically for important intellectual content, and final approval of the version to be published; Robin Remsburg was the chief of the long-term statistics branch at National Center for Health Statistics and participated in the development of the study questions, supervised data collection and database development, and was involved with interpretation of analyses, discussion, and review of the manuscript; Carol Hogue: review of data analysis and interpretation and preparation of the manuscript; Stefan Gravenstein: concept, design, interpretation, and manuscript.

Data were collected and made available by the National Center for Health Statistics, CDC.

We would like to thank James A. Singleton, MS, for statistical consultation and help with the analyses

Stefan Gravenstein is a consultant for Novavax, Merck, and GlaxoSmithKline; and is on the speakers bureau for SanofiAvenstis Pasteur and GlaxoSmithKline.

All other authors have no conflicts of interest.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Geriatrics & Gerontology
  • Gerontology
  • vaccination
  • nursing home
  • racial disparity
  • influenza
  • NNHS

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


Journal Title:

Journal of the American Geriatrics Society


Volume 59, Number 4


, Pages 687-693

Type of Work:

Article | Post-print: After Peer Review


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.

Copyright information:

© 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society

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