Commentary—Anatomy of Racial Disparity in Influenza Vaccination

Fiscella, Kevin

doi:10.1111/j.1475-6773.2005.0w372.x

Cited by 49 publications

(25 citation statements)

References 41 publications

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“…4,5,32 The causes of these residual disparities may include unmeasured factors such as attitudes toward particular procedures, costs not fully covered by insurance, language, and health literacy. [33][34][35] Our findings suggest that although frequency of primary care visits are in general strongly linked to receipt of preventive services, they seem to contribute relatively little to racial and ethnic disparities in receipt of these services. Instead, socioeconomic characteristics associated with poverty such as low educational attainment and low income, in addition to availability of supplemental insurance and health status, explain much of these disparities and also contribute to fewer visits.…”

Section: Discussionmentioning

confidence: 79%

Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States

Fiscella¹,

Holt²

2007

The Journal of the American Board of Family Medicine

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Background:The causes of racial and ethnic disparities in preventive care are not fully understood. We examined the hypothesis that fewer primary care visits by minority patients contribute to these disparities.Methods: We analyzed claims for Medicare beneficiaries 65 and older who participated in the Medicare Current Beneficiary Survey, 1998 to 2002. Five preventive services were included: colorectal cancer testing, influenza vaccination, lipid screening, mammography, and Papanicolaou smear screening. In separate multivariate analyses, we examined the effect of minority status (self-report of African American race or Hispanic ethnicity) on having a claim in the past 12 months for each preventive service after successive control for number of primary care visits and other patient characteristics.Results: The final sample included 15,962 subjects. In age-adjusted analyses, minorities had statistically lower rates of claims for each of the 5 procedures. After controlling for number of primary care visits, the effect of minority status was slightly attenuated but remained statistically significant for receipt of each procedure. After adding low income, low educational level and supplementary insurance, health status, and year, minority status was significantly associated only with colorectal cancer screening (odds ratio [

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Section: Discussionmentioning

confidence: 79%

Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States

Fiscella¹,

Holt²

2007

The Journal of the American Board of Family Medicine

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“…It is known that factors resulting in racial/ethnic disparities in access to health care are complex and multifactorial 40 and that key factors in the receipt of preventive care include system-related barriers, economic barriers, and sociocultural components. 39,41 Previous studies have shown that patient navigation-a process by which an individual guides patients with health-related problems through barriers in the complex care system-can decrease racial/ethnic disparities in cancer care. 42 Other studies have demonstrated that office-based multi-method interventions in inner-city practices can increase childhood immunization rates.…”

Section: Discussionmentioning

confidence: 99%

Increasing Inner-City Adult Influenza Vaccination Rates: A Randomized Controlled Trial

et al. 2011

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Objectives. In a population of seniors served by urban primary care centers, we evaluated the effect of the practice-based intervention on influenza immunization rates and disparities in vaccination rates by race/ethnicity and insurance status.Methods. A randomized controlled trial during 2003-2004 tested patient tracking/recall/outreach and provider prompts on improving influenza immunization rates. Patients aged $65 years in six large inner-city primary care practices were randomly allocated to study or control group. Influenza immunization coverage was measured prior to enrollment and on the end date.Results. At study end, immunization rates were greater for the intervention group than for the control group (64% vs. 22%, p,0.0001). When controlling for other factors, the intervention group was more than six times as likely to receive influenza vaccine. The intervention was effective across gender, race/ ethnicity, age, and insurance subgroups. Among the intervention group, 3.5% of African Americans and 3.2% of white people refused influenza immunization.Conclusions. Patient tracking/recall/outreach and provider prompts were intensive but successful approaches to increasing seasonal influenza immunization rates among this group of inner-city seniors.

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“…41 A key component of tailored approaches is the promotion of trust. 42 For example, engaging opinion leaders-both within the institution and in the communitywho can promote vaccination and provide culturally targeted messaging may aid in reducing racial/ethnic disparities. 43 Approaches to promoting trust in different institutions and populations may vary, and thus tailored interventions will require understanding local circumstances.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Vaccine Concerns on Racial/Ethnic Disparities in Influenza Vaccine Uptake Among Health Care Workers

et al. 2015

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Objectives. We explored whether collective concerns about the safety, effectiveness, and necessity of influenza vaccines mediate racial/ethnic disparities in vaccine uptake among health care workers (HCWs). Methods. We used a self-administered Web-based survey to assess race/ethnicity (exposure), concerns about influenza vaccination (mediator; categorized through latent class analysis), and influenza vaccine uptake (outcome) for the 2012 to 2013 influenza season among HCWs at St. Jude Children’s Research Hospital in Memphis, Tennessee. We used mediation analysis to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for the total, direct, and indirect effects of race/ethnicity on influenza vaccine uptake. Results. Non-Hispanic Blacks had lower influenza vaccine uptake than non-Hispanic Whites (total effect: PR = 0.87; 95% CI = 0.75, 0.99), largely mediated by high concern about influenza vaccines (natural indirect effect: PR = 0.89; 95% CI = 0.84, 0.94; controlled direct effect: PR = 0.98; 95% CI = 0.85, 1.1). Hispanic and Asian HCWs had modestly lower uptake than non-Hispanic Whites, also mediated by high concern about influenza vaccines. Conclusions. Racial/ethnic disparities among HCWs could be attenuated if concerns about the safety, effectiveness, and necessity of influenza vaccines were reduced.

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Commentary—Anatomy of Racial Disparity in Influenza Vaccination

Cited by 49 publications

References 41 publications

Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States

Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States

Increasing Inner-City Adult Influenza Vaccination Rates: A Randomized Controlled Trial

The Impact of Vaccine Concerns on Racial/Ethnic Disparities in Influenza Vaccine Uptake Among Health Care Workers

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