Influenza Immunization Coverage among Residents of Long-Term Care Facilities Certified by CMS, 2005-2006

Background:
In October, 2005 the Centers for Medicare and Medicaid Services (CMS) required that long-term care (LTC) facilities certified by CMS offer each resident annual influenza vaccination. Subsequently, vaccination status was added to resident assessments collected during the influenza season, October 1 through March 31. This is the first year immunization coverage can be reported by state. An estimated 98.8% of U.S. nursing home residents live in CMS certified homes.

Objectives:
Report influenza immunization coverage for LTC residents by state and examine coverage overall and by race between states. Examine proportions offered the vaccine and refusal levels between states by race.

Methods:
Use CMS' Minimum Data Set which consists of all resident assessments conducted October 1, 2005 through March 31, 2006 to determine if residents were ever offered the vaccine, vaccinated, or refused the influenza vaccine. Individuals are the unit of analysis.

Results:
The median proportion of residents offered the influenza vaccine in all U.S. states and the District of Columbia was 81.0% (range: 66.7%-91.8%). The proportion of whites offered the vaccine (median 81.6%) differed from blacks (median 77.2%), and this varied significantly by state (median difference: 3.1%; range: -11.3% to 21.9% among states). The median influenza vaccination coverage among LTC residents during '05-'06 was 69.3% (range: 38.0%-83.6% among states). Overall, whites had higher median levels of vaccination than blacks (69.8% vs 62.8%). The median proportion of refusals by state was 10.5% (range: 5.8% to 29.8%); this varied widely by race between states, with a median 10.7% of whites refusing and median 14.6% blacks refusing.

Conclusions:
Influenza vaccination coverage among residents of long-term care facilities varies between states and tends to be higher among whites than among blacks. Data suggest state level black-white differences in vaccination are related both to differences in offering vaccine, and differences in accepting it.