How Influenza Vaccination Rate Variation Could Inform Pandemic-Era Vaccination Efforts
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J Gen Intern Med DOI: 10.1007/s11606-020-06129-x © Society of General Internal Medicine 2020
INTRODUCTION
With the coronavirus disease 2019 (COVID-19) pandemic persisting and an influenza season looming, preparing a public health strategy to approach herd immunity to influenza is critical to preserving health care capacity and saving lives. Influenza led to 45 million symptomatic cases and 61,000 deaths in the 2017–2018 season, but under half of US adults and two-thirds of children are vaccinated.1, 2 The Centers for Disease Control and Prevention (CDC) recommends all persons 6 months of age or older without contraindications receive the influenza vaccine annually, especially those at higher risk for complications (e.g., older age, underlying medical conditions).2 Expanding upon earlier research on influenza vaccination disparities in 2011–2012,3 we use 2018 data to provide updated vaccination rates and identify rate variations informative to public health efforts to control influenza transmission and develop an outreach strategy for COVID-19 and other pandemic-related vaccination.
METHODS
We analyzed rates of self-reported influenza vaccination in the last 12 months recorded in the 2018 wave of the Behavioral Risk Factor Surveillance System (BRFSS), an annual national survey of 400,000+ US adults conducted by the CDC and state health departments. The 2018 data capture vaccinations for late 2017–2018 and early 2018–2019 influenza seasons. We report vaccination rates nationally and by state, age, race, sex, annual household income, chronic condition, health insurance (yes/no), and personal doctor (yes/ no) subgroups weighted by BRFSS survey weights for national representativeness. Chronic conditions were defined from self-reports if respondents were ever told they had a heart attack, angina or coronary heart disease, asthma, any cancer other than skin cancer, chronic obstructive pulmonary disorder or emphysema or chronic bronchitis, arthritis, kidney disease, or diabetes. Multivariable logistic Received June 22, 2020 Accepted August 10, 2020
regression was used to test for independent associations between factors of interest and odds of having received vaccination.
RESULTS
Data on influenza vaccination were available for 95.3% of 437,436 BRFSS respondents. Nationally, an estimated 33.2% of adults were vaccinated. Vaccination rates were higher among older, white and Asian, female, and higher income adults and those with chronic conditions (Table 1). In multivariable regression, these factors were all independently associated with higher odds of vaccination (Table 1). Ages 75+ had three times higher adjusted odds of vaccination than ages 18–24. Black and Native American adults both had 17% lower odds of vaccination than white adults. Having health insurance and having a personal doctor were both independently associated with two times greater odds of being vaccinated. Comparing states, there was variation in weighted vaccination rates ranging from 26.4% in Texas to 44.2% in the District of Columbia (Fig. 1).
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