Influenza, pneumococcal, hepatitis B and tetanus toxoid vaccination of Texas adults: The impact of border residence and acculturation

The Advisory Committee on Immunization Practices currently lists 10 vaccines on its recommended adult schedule. Surveillance of adult immunization practices can identify areas or populations with low vaccine coverage that may benefit from intervention to increase immunization rates. This study examines factors that may be associated with whether Texas adults receive several vaccines, including residence along the border and acculturation.

Self-reported data for influenza, pneumococcal, hepatitis B, and tetanus vaccines for adults ≥18 years were obtained from the 2007 Texas Behavioral Risk Factor Surveillance System (BRFSS). This survey included oversampling of the border counties of Texas. SAS-callable SUDAAN was used to calculate prevalence estimates and estimate multiple logistic regression models. All models included age group, race/ethnicity, sex, education level, whether the respondent had a recent physical exam, border or non-border residence, country of birth, and language used for the survey. The influenza and pneumococcal models also included a self-rating of general health and whether or not the respondent was diabetic. The hepatitis B model also included the presence of one or more known risk factors.

Overall self-reported immunization rates (preliminary estimates) for Texas adults were 36.4% for influenza, 65.5% for pneumococcal (adults ≥65 years), 37.3% for hepatitis B, 46.4% for tetanus, and 30.8% for all age-recommended vaccines. After adjusting for other variables, influenza and overall age-recommended immunization rates were lower in border areas (odds ratios 0.75 and 0.77, respectively). English speakers had higher immunization rates for pneumococcal and hepatitis B vaccines, while Spanish speakers had higher rates for tetanus vaccine.