Unpacking Intersectional Inequities in Flu Vaccination by Sexuality, Gender, and Race-Ethnicity in the United States

Abstract

Health care research has long overlooked the intersection of multiple social inequalities. This study examines influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity. Using data from the 2013 to 2018 National Health Interview Survey (N = 166,908), the study shows that sexual, gender, and racial-ethnic identities jointly shaped flu vaccination. Specifically, White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Across Black, Hispanic, and White individuals, sexual minority women had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. Economic enabling, noneconomic enabling, and need-based factors together explained a substantial portion of these gaps. However, they cannot explain all the disadvantages faced by Black lesbian, bisexual, and heterosexual women and Black heterosexual men. Findings offer new evidence of hidden health care inequities and inform health policies from an intersectional perspective.

Evaluating equity-promoting interventions to prevent race-based inequities in influenza outcomes

“…Furthermore, existing racial and ethnic disparities in vaccine uptake exacerbate differences in the rates of severe influenza outcomes. Differences in vaccine uptake across populations might be due to a complex mix of factors, including mistrust in the healthcare system, lack of transportation or childcare, inability to take time off or to pay for the vaccine or the copay [11][12][13][14]. BIPOC populations are therefore more frequently exposed to influenza, more susceptible to infection, more likely to develop symptomatic disease, and more likely to progress to hospitalization or death [15,16].…”