Do Regional Racial Inequities for Influenza Vaccination Among Nursing Home Residents Narrow If Facility Vaccination Policies Exist?

Background: One study examining influenza vaccination among nursing home residents found racial inequities for receipt of the vaccine varied widely among regions. Another study suggested intervention at the facility level is warranted to improve quality indicator outcomes for whites and blacks and to reduce disparity.

Objectives: To determine if the regional racial disparity in influenza vaccination narrows if residents are in facilities with vaccination policies or programs.

Methods: This study uses the National Nursing Home Survey (2004), a cross-sectional survey. A total of 1,152 U.S. long-term care facilities were systematically sampled with probability proportional to bed size. A total of 12,857 non-Hispanic white and black residents were included in the analysis. Logistic regression was used to examine the relationship between race/ethnicity and receipt of influenza vaccination, adjusting for appropriate confounders, for each U.S. region. The four regional models were then compared to “full models,” that also included facility-level vaccination policies (e.g., standing orders, pre-printed forms), one at a time, and then all policies combined. Predicted margins (and t-tests) for receipt of vaccine by race were examined in the full models to determine if presence of vaccination policy(s) narrowed the racial immunization gap.

Results: The proportion of non-Hispanic white residents receiving influenza vaccination was similar among the 4 regions (range: 62.9% - 65.8%), but varied widely among non-Hispanic blacks (range: 47.1% - 64.9%). The regions with the largest racial inequity in vaccination coverage (i.e., proportion of non-Hispanic whites vaccinated – proportion of blacks vaccinated) were the Midwest and Western regions, with 11.2 and 19.5 percentage point differences, respectively. The existence of influenza vaccination policies or programs individually or combined did not significantly narrow the racial inequity in vaccination in any of the 4 regions.

Conclusions: This study suggests that more than specific immunization policies in nursing homes may be required to narrow the gaps in vaccination coverage between whites and blacks.