Improvement in adult vaccination rates still needed

Racial and ethnic disparities exist when it comes to the five vaccines routinely recommended for adults, a new study finds.

The rate of routine vaccination among adults remains suboptimal, particularly among racial and ethnic minority groups, according to the results of a study published recently in the American Journal of Preventive Medicine.

“Substantial improvement in vaccination of recommended groups is needed to maximally reduce the health impact of vaccine-preventable diseases,” Peng-jun Lu, MD, PhD, from the Immunization Services Division of the National Center for Immunization and Respiratory Diseases at the CDC, told Medical Economics.

According to Lu, reducing racial/ethnic disparities in immunization rates is a compelling public health goal.

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“Lower vaccination coverage among racial/ethnic populations can increase their risk for contracting these infections and the potential for complications and adverse sequelae,” Lu said. “Assessing adult vaccination by race/ethnicity in the United States is helpful in developing strategies to reduce racial/ethnic disparities in adult vaccination coverage.”

To do that, Lu and colleagues analyzed data from 34,218 adults from the 2012 National Health Interview Survey on the rates of vaccination against influenza, tetanus, pneumococcal, human papilloma virus, and herpes zoster.

They found that the rates of vaccination coverage varied greatly by ethnic minority group (see table). Overall, non-Hispanic blacks were significantly less likely to be vaccinated compared with non-Hispanic whites, with the exception of pneumococcal vaccination among people aged 19-64 with high-risk conditions. Hispanics also had significantly lower rates of vaccinations compared with non-Hispanic whites.

Table. Rate of Vaccination by Age, Race/Ethnicity

-InfluenzaInfluenzaPneumococcalPneumococcalTdTdHerpes ZosterHPV
Non-Hispanic Whites33.5%68.8%21.4%64.0%68.9%57.7%22.8%42.2%
Non-Hispanic Blacks27.5%53.0%19.7%46.1%54.9%44.6%8.8%29.1%

The researchers found smaller disparities for influenza and pneumococcal vaccinations among adults aged 19 to 64 compared with adults aged 65 or older.

In a multivariable analysis, Lu and colleagues controlled for age, sex, marital status, education, employment status, health insurance, number of annual doctor visits, and more, and found that non-Hispanic blacks, Hispanics, and non-Hispanic Asians were still significantly less likely to obtain vaccinations compared with non-Hispanic whites. The coverage gaps found after these sociodemographic and access-to-care factors were taken into account were narrower than in the univariable analysis, but most of the disparities remained.

The study showed that higher education, higher income, and health insurance all had a positive effect on adult vaccination coverage. According to Lu, lack of medical insurance has been an important predictor of low adult vaccination coverage.

“The Affordable Care Act and other healthcare reform holds the promise of reducing the number of uninsured adults and related barriers to care and reducing missed opportunities for vaccination related to health insurance coverage and access to care,” Lu said. “Broad use of interventions to remove barriers to access and to make offering of adult vaccines in health care and other settings a routine practice is important components of efforts to reduce adult vaccination disparities will also be needed to increase rates and close gaps in adult vaccination coverage.”