Among Medicare beneficiaries 65 years and older, substantial racial and ethnic disparities in the uptake of both seasonal influenza vaccine (SIV) and high-dose vaccines (HDV) existed during the 2015-2016 season, and these persisted even among individuals who were vaccinated, according to results from a recent historical record-linkage study published in The Lancet.
Researchers reported that flu vaccine coverage was less than 50% in older U.S. adults, and that Black, Hispanic, and Asian Americans were less likely to be vaccinated, with Hispanics being the least likely. Further, vaccinated Black, Hispanic, and Asian individuals were all 30%-48% less likely to have received the high-dose vaccine used to vaccinate non-Hispanic white individuals.
In the United States, adults aged 65 years and older represent an estimated 900,000 to 5,800,000 cases of seasonal flu annually and are at greater risk for severe disease. Further, in older adults, standard influenza vaccines frequently fall short in protective benefits. Also increasing the burden in this population are findings that non-Hispanic Black individuals have the highest flu-related hospital admission rates in the country, and Hispanic or Latino individuals have the third highest flu-related hospital admission rates and are at higher risk of exposure to the virus compared with non-Hispanic White individuals.
“In the USA, annual administration of an SIV is recommended for people at high risk of serious illness and death due to influenza, including all adults [age] 65 years or older, who account for most influenza-related deaths and hospital admissions. However, SIV uptake among this age group remains suboptimal, leveling off at approximately 65% since 1998. Concern is also growing about racial and ethnic disparities in SIV uptake. In a meta-analysis in 2019, we found that community-dwelling (non-institutionalized) Black and Hispanic adults aged 65 years or older had consistently lower SIV uptake than white adults…” wrote Salaheddin M. Mahmud, MD, MSc, PhD, FRCP, University of Manitoba, Winnipeg, Manitoba, Canada.
Using Medicare databases, Mahmud and fellow researchers identified 26.5 million older adults aged 65 years and older who were enrolled from July 1, 2015 to June 30, 2016. During this time, 47.4% had received an SIV, of whom 52.7% received the HDV—a trivalent, inactivated, unadjuvanted SIV for use in adults aged 65 years and older as an alternative to the standard-dose vaccine.
Compared with White individuals, Hispanic, Black, and Asian beneficiaries were less likely to be vaccinated (49.4% versus 29.1%, 32.6%, and 47.6%, respectively). Further, when participants from these ethnicities were vaccinated, they were less likely to receive the HDV (53.8% of White versus 37.8%, 41.1%, and 40.3%, respectively).
Upon analysis of only individuals who were vaccinated, and after accounting for region, income, chronic conditions, and health care utilization, Mahmud and colleagues found that minority groups were 26%-32% less likely to receive HDV compared with White individuals as follows:
- Black: OR: 0.68; 95% CI 0.68-0.69.
- Asian: OR: 0.71; 95% CI 0.71-0.72.
- Hispanic: OR: 0.74; 95% CI 0.73-0.74.
Other findings include:
- A higher number of Asian individuals had no hospital admissions during the study compared with other groups (90.1%).
- Fewer Asian individuals had an emergency department visit (10.5% had one visit; 4.1% had two or more visits).
- Women were more likely to have been vaccinated than men (49.5% versus 44.8%, respectively), but less likely to get the HDV (52.1% versus 53.6%).
- Compared with urban dwelling individuals, rural residents were less likely to get the SIV (21.7%), and among those vaccinated, less likely to receive the HDV (45.3%).
- Individuals with chronic diseases were more likely to have been vaccinated than those without (54.0% versus 32.9%, respectively), but less likely to get the HDV (51.1% versus 58.7%).
- More frequent visits to physicians were associated with a greater likelihood of receiving an SIV, but not HDV.
“Influenza vaccination is the most important public health tool to prevent influenza illnesses, hospital admissions, and deaths, especially for older adults. Among older adults, the high-dose influenza vaccine is more immunogenic and more efficacious than the standard dose, and therefore could provide additional protection,” wrote Maria E. Sundaram, PhD, of ICES, Toronto, Ontario, Canada, and John R. Pamplin II, PhD, MPH, of New York University, New York City, in an accompanying editorial.
“The study by Mahmud and colleagues highlights the reality that public health programmes that are implemented without explicit consideration of racial equity frequently produce inequities downstream. In some cases, the magnitude of these disparities might eclipse the effectiveness of the programme itself. Interventions to resolve these disparities should therefore be a primary focus among influenza epidemiology research, lest we forget a core tenet of vaccine epidemiology: vaccines do not save lives— vaccinations do,” Sundaram and Pamplin concluded.
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Flu vaccine coverage includes less than 50% of U.S. adults age ≥65 years, and major racial/ethnic disparities in vaccine coverage persist, researchers found.
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Black, Hispanic, and Asian American patients were all less likely to be vaccinated than non-Hispanic White patients, with Hispanics being the least likely.
Liz Meszaros, Contributing Writer, BreakingMED™
This study was funded by Sanofi Pasteur.
Mahmud has received unrestricted research grants from GlaxoSmithKline, Merck, Pfizer, Sanofi Pasteur, and Roche-Assurex for unrelated studies; and fees as a consultant and advisory board member for GlaxoSmithKline, Merck, Pfizer, Sanofi Pasteur, and Seqirus
Sundaram and Pamplin reported no disclosures.
Cat ID: 31
Topic ID: 79,31,282,562,31,255,561,151,925
