Socioeconomic Status Doesn't Explain Racial Gap in Vaccine Rates

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Flu Vaccination Rate and Race

Elderly blacks and Hispanics are vaccinated against flu and pneumonia at levels 15 percent to 22 percent below whites, but the reason is not simply due to income, education or access to health care, two new studies reveal.

The influenza vaccine and pneumonia shot are both recommended for adults 65 and older. In one study, researcher Karen Lees, M.P.H., and colleagues compared the vaccination coverage against two cancer-detection tests recommended for older people, mammography and colorectal screening.

For breast cancer and colorectal screening, most of the racial or ethnic differences were explained by disparities in socioeconomic status, such as income and education, the study found. But Lees said, "After we accounted for socioeconomic status, the disparities in influenza and pneumococcal vaccine still remained."

The study did not identify why the differences existed, but Lees said personal attitudes, beliefs and knowledge may be among the obstacles that keep black and Hispanic seniors from seeking immunization or accepting it when it is offered.

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The findings are published in the latest American Journal of Preventive Medicine and are from researchers with the National Immunization Program at the Centers for Disease Control and Prevention. They drew on responses from the government's 2000 National Health Interview Survey and considered measures of socioeconomic status such as education, access to health insurance income and personal health.

A companion study by James A. Singleton, M.S., and colleagues suggested that among all ethnic groups the lack of a flu vaccine recommendation from a doctor played a larger role in missed shots than the patients' refusal to get one.

Unvaccinated survey respondents most often cited concerns about side effects or said they did not think they needed the shots, the study said.

Singleton found that the flu vaccination rate for blacks is 15 percentage points lower than for whites and for Hispanics is 18 percent lower. For pneumonia, blacks were vaccinated at a rate 19 percentage points less than whites and Hispanics almost 22 percent less.

The federal government has set a goal to have 90 percent of Americans age 65 or older immunized against flu and pneumonia by the 2010. But Singleton and his team found that only 68 percent of the seniors surveyed said they had received an influenza vaccination during the flu season when the survey was conducted. Sixty percent of respondents said they had a pneumonia shot.

Pascale Wortley, a researcher on both studies, said it is not easy to promote vaccination in adult medicine. While immunization is at the heart of pediatric medicine, that's not true for physicians who treat large populations of older patients, she said. "They have a lot of other priorities," she added.

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