(160) Influenza Vaccine Uptake Among United States Nursing Home Residents: Measuring Geographic Variation in Racial Health Disparities

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 834

Presenting Author(s)

Joe Silva
– Brown University School of Public Health, Providence, Rhode Island, United States

Co-Author(s)

Chanelle Howe, PhD
– Associate Professor, Brown University, United States
John Jackson, ScD
– Assistant Professor, Johns Hopkins University, United States
Barbara Bardenheier, PhD
– Assistant Professor, Brown University, United States
Melissa Reister, PharmD
– Postdoctoral Fellow, Brown University, Providence, United States
Robertus van Aalst, PhD
– Lead, Vaccine Epidemiology and Modeling, Sanofi Pasteur, United States
Matthew Loiacono, PhD
– Medical Evidence Generation Lead, Sanofi Pasteur, United States
Andrew R. Zullo, PharmD, PhD
– Associate Professor, Brown University School of Public Health, Brown University, Providence, Rhode Island, United States

Background: Influenza vaccination among nursing home residents in the United States (US) varies considerably by geography and race/ethnicity. However, little is known about how racial disparities in vaccine use among this population vary geographically.

Objectives: To identify the distribution of racial disparities in influenza vaccination among non-Hispanic White and Black nursing home residents among states and hospital referral regions (HRRs). We hypothesized that the largest disparities in vaccination would exist in the US Midwest.

Methods: A retrospective cohort study was conducted among a nationally representative population of short-stay (post-acute care) and long-stay (long-term care) US nursing home residents aged ≥65 years enrolled in Traditional Medicare across influenza seasons from October 1, 2011, to March 31, 2018. Race was measured using the Research Triangle Institute race variable. Influenza vaccination was measured using resident Minimum Data Set assessments from October 1st through June 30th. We conducted our analyses at the person-period, or “resident-season,” level. Residents only contributed person-time during influenza seasons (October 1 – March 31), and therefore could be represented as multiple observations across influenza seasons if they remained in a nursing home. Nonparametric g-formula using fully saturated linear models were used to calculate age- and sex-standardized estimates of vaccination. Disparities were measured in aggregate as the percentage point difference in the proportion of individuals vaccinated between Black and White nursing home residents among states and HRRs.

Results: The study included 7,807,187 short-stay resident-seasons (89.7% White and 10.3% Black) in 14,889 nursing homes and 7,308,111 long-stay resident-seasons (86.7% White and 13.3% Black) in 14,885 nursing homes. The median standardized disparity between White and Black short-stay resident-seasons at the state level was 10.11 percentage points (N=34; interquartile range, 4.12; minimum-maximum, 4.91-23.20) and 5.32 percentage points (35; 3.14; 1.16-16.57) among long-stay resident-seasons. Among HRRs, the median standardized difference among short-stay resident-seasons was 8.58 percentage points (106; 5.84; -6.37-26.19) and 4.95 percentage points (110; 3.90; -2.20-20.71) among long-stay resident-seasons.

Conclusions: Wide geographic variation of racial disparities in influenza vaccination was observed for both short- and long-stay residents across states and HRRs. Understanding the geographic distribution of vaccination by racial group can aid in the development of targeted interventions to increase vaccine uptake and promote health equity.