Black People Still Less Likely to Get Flu Shots in US Nursing Homes

By Will Boggs MD

October 29, 2020

NEW YORK (Reuters Health) - Black nursing home residents continue to be less likely than their white peers to receive influenza vaccinations, mainly due to refusals, according to data from the U.S. Centers for Medicare and Medicaid Services (CMS).

"Nursing home residents are at increased risk of complications from influenza and may benefit from herd-immunity; therefore, it's important to ensure that all eligible residents are vaccinated," Dr. Barbara H. Bardenheier of Brown University School of Public Health, in Providence, Rhode Island, told Reuters Health by email.

Influenza-vaccine coverage rose from 71.4% in 2005-06, when the CMS first began requiring nursing homes to offer influenza vaccines to residents, to 73.0% in 2017-18. But at the same time, the gap in coverage between white and Black people increased from 7.1 to 9.5 percentage points, Dr. Bardenheier and colleagues write in Clinical Infectious Diseases.

The researchers used CMS data to determine if the 6.9-percentage-point difference between whites and Blacks seen during the 2008-09 season persisted in 2018-19.

Overall vaccination coverage in 2018-19 was 76.2% among White nursing home residents versus 66.3% among Black nursing home residents, a 9.9-percentage-point difference, the team found.

The disparity was at least 10 percentage points in 14 states, 5.0-9.9 percentage points in 21 states and 1-4.9 percentage points in five states.

Inequities were concentrated in the Midwest, which was also the most segregated region.

In states with a disparity of at least 10 percentage points, vaccination rates were highest in facilities with no Blacks and lowest in facilities with at least 50% Blacks, and Blacks disproportionately lived in nursing homes with at least 50% Blacks.

The overall proportion of residents not offered the vaccine was 3%, a proportion that differed little between whites (2.6%) and Blacks (4.8%), whereas vaccination refusals were higher among Black residents (28.7%) than among white residents (21.0%).

"A major reason for the White-Black difference in vaccination was due to black residents refusing vaccine more often," Dr. Bardenheier said. "Although standing orders for vaccinations in nursing homes has been associated with higher vaccination coverage and lower rates of racial disparities, addressing patients' and their families' concerns and misperceptions about the flu vaccine may also reduce the disparity."

SOURCE: Clinical Infectious Diseases, online September 29, 2020.