title: Influenza and pneumococcal vaccination among Native American elders in a primary care practice.
abstract: BACKGROUND
  More than 2 million Native Americans (ie, Native Americans and Native Alaskans) live in the United States; 60% reside in cities. This population, especially its elders, is especially susceptible to respiratory diseases; yet, adherence to guidelines for influenza and pneumococcal immunizations is unknown.
  
  
  OBJECTIVE
  To evaluate how frequently older and high-risk adults received vaccinations for influenza and pneumococcal infection and to identify patient characteristics associated with adherence to published recommendations.
  
  
  METHODS
  Retrospective medical record review of 550 Native American elders seen in an urban primary care practice defined using a culturally appropriate age threshold (> or =50 years) and standard criteria (> or =65 years). Univariate analyses examined demographic and clinical information by vaccination status. Logistic regressions identified factors associated with adherence to immunization guidelines.
  
  
  RESULTS
  Among patients aged 50 years and older with any indication according to published recommendations, rates were low for influenza (31%) and pneumococcal (21%) immunizations. Likewise, few subjects at least 65 years of age had been immunized appropriately against influenza (38%) or pneumococcus (32%). Younger age and alcohol use were significantly associated with less frequent immunization; Medicare insurance, depression, and more health problems and taking more medications predicted significantly higher immunization rates. Aged 65 years or older and having cardiovascular disease or diabetes mellitus were specific indications significantly correlated with receipt of influenza and pneumococcal vaccine.
  
  
  CONCLUSIONS
  Regardless of age or risk, inadequate vaccination rates were observed in elderly Native Americans. Our findings suggest the need to identify obstacles to immunization and to conduct prospective and elderly intervention studies in Native American populations.
authors.affiliation: Department of Medicine, University of Washington, Seattle, USA. dedra@u.washington.edu
authors.forename: D
authors.initials: D
authors.lastname: Buchwald
authors.forename: J
authors.initials: J
authors.lastname: Sheffield
authors.forename: R
authors.initials: R
authors.lastname: Furman
authors.forename: S
authors.initials: S
authors.lastname: Hartman
authors.forename: M
authors.initials: M
authors.lastname: Dudden
authors.forename: S
authors.initials: S
authors.lastname: Manson
mesh_terms: D000368:Aged; D001428:Bacterial Vaccines / Q000008:administration & dosage*; D004363:Drug Utilization; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007115:Immunization Schedule; D007198:Indians, North American / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000517:prevention & control; D011320:Primary Health Care; D014861:Washington
chemical_list: D001428:Bacterial Vaccines; D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines