Online Program

Disparities in Influenza Vaccination of Chronically-ill US Adults: The Mediating Role of Perceived Discrimination in Healthcare

Tuesday, November 3, 2015

William Bleser, PhD (c), MSPH, Department of Health Policy and Administration; Demography Program, Pennsylvania State University, University Park, PA
Patricia Y. Miranda, MPH, PhD, Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA
Muriel Jean-Jacques, MD, MAPP, General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine
Despite well-established adult influenza vaccination programs, adult influenza vaccination rates in the US are well below federal benchmarks and exhibit well-documented, persistent racial and ethnic disparities. Understanding the contributors to vaccination disparities among chronically-ill adults is of particular importance since this population is at higher risk for influenza-related complications. The causes of disparities in influenza vaccination are multifactorial and complex, but perceived racial and ethnic discrimination in healthcare is one hypothesized mechanism. The objective of this study is to assess the role of perceived discrimination in healthcare in explaining racial/ethnic disparities in influenza vaccination. This study uses data collected from 2011-2012 from the AF4Q Consumer Survey, a nationally-representative survey of chronically-ill US adults focused on health and healthcare (n=9,572). It compares findings with the limited, mixed literature on the effects of discrimination on vaccination and it advances upon prior research by examining the role of discrimination as a mediator between race/ethnicity and influenza vaccination using binary mediation analysis. In unadjusted analyses, 59% of respondents with no experiences of perceived discrimination reported receiving the influenza vaccine compared to only 36% in those who had experienced discrimination (p=0.04). By race/ethnicity, 45% of non-Hispanic Blacks reported influenza vaccination compared to 57% of non-Hispanic Whites and 60% of Hispanics, though this was not a statistically significant disparity. Though the odds ratio of flu vaccination given perceived discrimination was not significant in the fully-adjusted model, the magnitude of the effect was fairly large and approached significance (OR 0.40, 95% CI: 0.15-1.10), and model fit (AIC and pseudo R2) improved when the discrimination variable was included. Perceived discrimination in healthcare significantly mediated about 17% of the unadjusted association between race/ethnicity and influenza vaccination, though this mediation dropped to 5% and the mediation coefficient lost statistical significance in the fully-adjusted model. The lack of statistical significance of the result may be due to sample size and sample weighting. The causes of persistent racial disparities in influenza vaccination are undoubtedly complex and a single explanation is unlikely to be sufficient. Current evidence elucidating discrimination and other mechanisms of racial/ethnic disparities is limited and this potential mediating pathway merits re-evaluation in a larger cohort.

Learning Areas:

Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
Describe the association of patient-perceived racial/ethnic discrimination in the healthcare setting with the odds of receiving influenza vaccination. in chronically-ill US adults. Assess the role of patient-perceived discrimination in the healthcare setting as a potential mediating mechanism of racial and ethnic disparities in influenza vaccination in chronically-ill US adults.

Keyword(s): Immunizations, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the lead author of this paper. I have an MSPH in international health with a graduate minor in Vaccine Science & Policy and I completed a one-year fellowship related to vaccine safety and vaccine policy for Health & Human Services. My dissertation will focus on better understanding the determinants and impact of influenza vaccination in young children as well as assess policy to improve influenza vaccination in young children.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.