Race and Ethnicity are Determining Flu Vaccine Rates in Medicare

Historical record-linkage cohort study in The Lancet using Medicare databases shows substantial racial and ethnic disparities in Seasonal Influenza Vaccine uptake that are informed by beneficiaries’ race and ethnicity

WASHINGTON, D.C.—Today, National Minority Quality Forum (NMQF) announced an urgent call for new legislative, fiscal, and educational strategies to address substantial racial and ethnic disparities in seasonal influenza vaccine (SIV) uptake among Medicare beneficiaries aged 65 years or older based on study findings published in The Lancet, “Effect of race and ethnicity on influenza vaccine uptake among older US Medicare beneficiaries: a record-linkage cohort study”.

The study found that people from racial and ethnic minority groups were significantly less likely than white people to receive SIV. These findings are alarming because they point to a level of disparity in vaccine uptake that can hamper efforts to reduce the health and economic burdens of influenza, which remain substantial despite decades of intense public health efforts.

“Annual administration of a SIV is recommended for people at high risk of serious illness and death due to influenza, including all adults aged 65 years or older, who account for most influenza-related deaths and hospital admissions,” said Professor Salaheddin M Mahmud, the lead author of the study. “However, SIV uptake among this age group remains suboptimal, levelling off at approximately 65% since 1998. And, it’s worse for racial and ethnic minority groups.”

“By limiting the analysis to people who were vaccinated”, writes Mahmud et al., “we were able to rule out several often-cited justifications for inequities in vaccine uptake, such as higher amounts of vaccine hesitancy and distrust of public institutions among minority groups, living circumstances (e.g., homelessness), or limited physical access to preventive services. Another important finding was that these disparities in  uptake could not be fully explained by ethnic differences in age, gender, place of residence, Medicare status, pre-existing chronic diseases, intensity of health-care use, or region.”

The authors concluded that “Our findings point to structural deficits systematically hampering access to influenza vaccination … driven by deeply ingrained and often subtle systemic prejudices and discriminatory policies and practices.”

A companion commentary to the Mahmud article observed, “the authors explicitly defined and analysed race as a social construct, outlining a causal framework that placed race—and thereby racism—as the originating factor for associated determinants of vaccine uptake. In doing so, the authors were able to appropriately conceptualise factors including income and patterns of health-care use (commonly associated with race) as mediators (not confounders) of the relationship between race and vaccination status. This analytical approach highlights race, rather than social class, as the salient factor for observed disparities, while also identifying mechanisms such as differential income as illustrations of structural racism—rather than separate independent factors”.

“Disparities in vaccine administration is not a new finding as it is well known that comparatively speaking African Americans have had the worst health outcomes in Medicare since the beginning of the program. The ineffective response to this inequity is only further evidence of the systemic prejudices and discriminatory policies and practices that Mahmud et al found for vaccine administration,” concludes Gary A. Puckrein, PhD, President of the National Minority Quality Forum.

“The new administrator of the Medicare program, Chiquita Brooks-LaSure, has indicated that under her leadership these historic inequities will be addressed.  Improving flu vaccination rates for racial and ethnic beneficiaries who have been underserved would be a strong indication that her administration is serious about eliminating disparities in Medicare.”

Professor Salaheddin M Mahmud, MD, of the University of Manitoba’s Vaccine and Drug Evaluation Centre, Rady Faculty of Health Science; Edward Thommes, PhD, Matthew M Loiacono, PhD, and Ayman Chit, PhD, of  Sanofi Pasteur; and NMQF’s Liou Xu, PhD, Laura Lee Hall, PhD, and Gary Puckrein, PhD, authored the report.

For more, read the paper in full

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About National Minority Quality Forum
The National Minority Quality Forum (NMQF) is a 501(c)(3) not-for-profit research and advocacy organization based in Washington, DC. The mission of NMQF is to reduce patient risk by assuring optimal care for all. NMQF’s vision is an American health services research, delivery and financing system whose operating principle is to reduce patient risk for amenable morbidity and mortality while improving quality of life. NMQF’s capabilities include federal and state policy analysis and advocacy; issue-specific alliance development; community-based provider quality improvement initiatives, and data analytics.