Disparities in influenza vaccination coverage among health care providers: Nursing home nursing assistants (NAs) the forgotten workers

Data from the National Health Interview Survey suggest that there is a widening disparity in influenza vaccination coverage rates between nursing home nurses assistants and other hospital and nursing home-based health care personnel. The approximately 600,000 nursing assistants (NAs) working in the nation's nursing homes provide 90% of hands-on resident care. Vaccination of NAs is important for reducing their rates of illness and absenteeism and for the protection of their patients. To establish factors associated with influenza vaccination coverage among NAs working in US nursing homes, we analyzed data from the National Nursing Assistant Survey, a stratified, multistage probability sample of 582 nursing homes in which 3,017 NAs were sampled. The influenza vaccination coverage for NAs working in US nursing homes was estimated to be 37.1%. Age was positively associated with vaccination status (p<0.01), with category coverage ranging from 31.7% among 16–34 year olds to 75.6% among those 65 years and older. Among racial/ethnic subpopulations, vaccination coverage was significantly lower for non-Hispanic blacks, than for both non-Hispanic whites (p<0.01) and Hispanics/Latinos (p<0.01). Among the 9.1% of NAs whose employers did not offer some kind of health coverage, only 28.2% were vaccinated while those whose employers did offer health coverage, vaccination coverage was 38.0%. (p=0.01). Vaccination coverage for NAs working in private or government not-for-profit facilities (43.2%) was significantly higher (p<0.01) than for those who worked in for-profit facilities (32.8%). These findings suggest the need for improved vaccination programs especially targeting the underserved nursing home nursing assistant population.