Factors associated with African Americans' utilization of influenza vaccination

Background: Racial disparities exist in influenza vaccination coverage.  African Americans obtained fewer influenza vaccinations in comparison to non-Hispanic whites.  Scant research has explored factors that could influence African Americans use of influenza vaccinations.

Objective:To determine factors that are related to the receipt of influenza vaccinations in African Americans age 18 and older in the past 12 months.

Design:The 2010 Medical Expenditure Panel Survey was used with 12,511 African American adults (n=78,757,964 weighted) selected as the study population. The dependent variable was the receipt of an influenza vaccination within the past year (yes/no). The Andersen Model of Health Care Utilization was used to guide the selection of independent variables. Predisposing factors (age, sex, marital status, education and employment), enabling factors (income, physician visits, insurance status, usual source of health care, routine check-up, and region census) and need factors (perceived health status and presence of medical conditions that are likely to have flu-related complications) comprised the independent variables. Logistic regression analyses, incorporating the sampling weights, were employed. All analyses were conducted using STATA (version 13).

Results: Forty-four percent of African Americans received influenza vaccination within the past year. Predisposing factors such as age (OR 1.02, 95% CI 1.01 to 1.03) and unemployment status (OR 1.50, 95% CI 1.08 to 2.09) were positively associated with influenza vaccinations.  African Americans who had private insurance (OR 1.722, 95% CI 1.07 to 2.77), a routine check-up within the past year (OR 2.12, 95% CI 1.52 to 2.95) or had more than 4 visits to physicians in 2010 (OR 1.72, 95% CI 1.23 to 2.41) were more likely to receive an influenza vaccination in comparison to African Americans without those enabling factors.  In addition, African Americans who had HIV (OR 6.00, 95% CI 2.24 to 16.07), diabetes (OR 1.90, 95% CI 1.35 to 2.68) or asthma (OR 1.48, 95% CI 1.05 to 2.08) were more likely to report receipt of influenza vaccine than respondents without those medical conditions.

Conclusions: Study findings indicate that African Americans with access to the health care system are more likely to receive influenza vaccinations.  However, results also show that individuals with particular medical conditions that are sensitive to influenza (e.g. heart disease) are not receiving recommended services. Future research should identify and examine alternative methods to improve the utilization of influenza vaccinations in African Americans.