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Immunization disparities in older Americans: determinants and future research needs.
Am J Prev Med. 2006 Aug; 31(2):150-8.AJ

Abstract

BACKGROUND

Marked racial disparities persist in influenza and pneumococcal vaccinations among Medicare beneficiaries. This study sought to assess the contribution that patient, physician, health system, and area-level characteristics make to these racial disparities in immunization.

METHODS

Cross-sectional and decomposition analyses were performed on a nationally representative sample of 18,013 non-institutionalized Medicare beneficiaries who responded to the Medicare Current Beneficiary Survey (MCBS) in 2000 to 2002. The physician characteristics of interest included specialty type, accessibility, information-giving skills, perceived quality, and continuity of care. Health system characteristics included HMO enrollment and numbers of primary care physicians per elderly. The outcomes were receipt of influenza vaccine in the past year and ever having received a pneumococcal vaccine.

RESULTS

Immunization rates were below recommended levels for all Medicare beneficiaries. Disparities between white and black beneficiaries in the receipt of vaccinations were large-an absolute 17% difference for each vaccine. After adjusting for patient, physician, health system, and area-level characteristics, white beneficiaries had significantly higher odds of vaccination than did black beneficiaries: adjusted odds ratio (aOR) = 1.52 (95% confidence interval [CI] = 1.35-1.71) for influenza vaccination, and aOR = 1.82 (95% CI = 1.61-2.07) for pneumococcal vaccination. Beneficiaries with a usual physician that they rated as having good information-giving skills and whose practice was more accessible, had higher immunization rates. Beneficiaries with a primary care generalist as their usual physician had higher odds of immunization than those with a specialist as their usual physician. At the county level, a higher number of primary care physicians per elderly resident was associated with higher odds of immunization. Only 7% of the racial disparity in influenza immunization was explained by the measured characteristics of beneficiaries and their health systems.

CONCLUSIONS

Despite similar insurance coverage and presence of a usual physician, black beneficiaries were significantly less likely than their white counterparts to receive influenza and pneumococcal vaccinations. The implications for future research are discussed, including the need for system-based interventions that make the offering and discussion of vaccination routine.

Authors+Show Affiliations

Center for Studying Health System Change, Washington, DC 20024-2512, USA. aomalley@hschange.orgNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16829332

Citation

O'Malley, Ann S., and Christopher B. Forrest. "Immunization Disparities in Older Americans: Determinants and Future Research Needs." American Journal of Preventive Medicine, vol. 31, no. 2, 2006, pp. 150-8.
O'Malley AS, Forrest CB. Immunization disparities in older Americans: determinants and future research needs. Am J Prev Med. 2006;31(2):150-8.
O'Malley, A. S., & Forrest, C. B. (2006). Immunization disparities in older Americans: determinants and future research needs. American Journal of Preventive Medicine, 31(2), 150-8.
O'Malley AS, Forrest CB. Immunization Disparities in Older Americans: Determinants and Future Research Needs. Am J Prev Med. 2006;31(2):150-8. PubMed PMID: 16829332.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immunization disparities in older Americans: determinants and future research needs. AU - O'Malley,Ann S, AU - Forrest,Christopher B, Y1 - 2006/06/08/ PY - 2005/11/09/received PY - 2006/03/01/revised PY - 2006/03/29/accepted PY - 2006/7/11/pubmed PY - 2006/9/6/medline PY - 2006/7/11/entrez SP - 150 EP - 8 JF - American journal of preventive medicine JO - Am J Prev Med VL - 31 IS - 2 N2 - BACKGROUND: Marked racial disparities persist in influenza and pneumococcal vaccinations among Medicare beneficiaries. This study sought to assess the contribution that patient, physician, health system, and area-level characteristics make to these racial disparities in immunization. METHODS: Cross-sectional and decomposition analyses were performed on a nationally representative sample of 18,013 non-institutionalized Medicare beneficiaries who responded to the Medicare Current Beneficiary Survey (MCBS) in 2000 to 2002. The physician characteristics of interest included specialty type, accessibility, information-giving skills, perceived quality, and continuity of care. Health system characteristics included HMO enrollment and numbers of primary care physicians per elderly. The outcomes were receipt of influenza vaccine in the past year and ever having received a pneumococcal vaccine. RESULTS: Immunization rates were below recommended levels for all Medicare beneficiaries. Disparities between white and black beneficiaries in the receipt of vaccinations were large-an absolute 17% difference for each vaccine. After adjusting for patient, physician, health system, and area-level characteristics, white beneficiaries had significantly higher odds of vaccination than did black beneficiaries: adjusted odds ratio (aOR) = 1.52 (95% confidence interval [CI] = 1.35-1.71) for influenza vaccination, and aOR = 1.82 (95% CI = 1.61-2.07) for pneumococcal vaccination. Beneficiaries with a usual physician that they rated as having good information-giving skills and whose practice was more accessible, had higher immunization rates. Beneficiaries with a primary care generalist as their usual physician had higher odds of immunization than those with a specialist as their usual physician. At the county level, a higher number of primary care physicians per elderly resident was associated with higher odds of immunization. Only 7% of the racial disparity in influenza immunization was explained by the measured characteristics of beneficiaries and their health systems. CONCLUSIONS: Despite similar insurance coverage and presence of a usual physician, black beneficiaries were significantly less likely than their white counterparts to receive influenza and pneumococcal vaccinations. The implications for future research are discussed, including the need for system-based interventions that make the offering and discussion of vaccination routine. SN - 0749-3797 UR - https://www.unboundmedicine.com/medline/citation/16829332/Immunization_disparities_in_older_Americans:_determinants_and_future_research_needs_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0749-3797(06)00148-6 DB - PRIME DP - Unbound Medicine ER -