title: The causes of racial and ethnic differences in influenza vaccination rates among elderly Medicare beneficiaries.
abstract: OBJECTIVE
  To explore three potential causes of racial/ethnic differences in influenza vaccination rates in the elderly: (1) resistant attitudes and beliefs regarding vaccination by African-American and Hispanic Medicare beneficiaries, (2) poor access to care during influenza vaccination weeks, and (3) discriminatory behavior by providers.
  
  
  METHODS
  Medicare beneficiaries who responded to both the 1995 and 1996 Medicare Current Beneficiary Survey (MCBS) (n=6,746).
  
  
  METHODS
  We combined survey information from the MCBS with Medicare claims. We measured resistance to vaccination by self-reported reasons for not receiving vaccination, access to care by claims submitted during vaccination weeks, and discrimination by racial differences in vaccinations among beneficiaries who visited the same providers during vaccination weeks.
  
  
  RESULTS
  White beneficiaries (66.6 percent) were more likely to self-report having received vaccination than were African Americans (43.3 percent) or Hispanics (52.5 percent). Resistance to vaccination plays a role in low vaccination rates of African-American (-11.8 percentage points), but not Hispanic beneficiaries. Unequal access accounts for <2 percent of the disparity. Minority beneficiaries remained unvaccinated despite having medical encounters with their usual providers on days when those same providers were administering vaccinations to white beneficiaries. This disparity is attributable not to provider discrimination but to a 1.6-5 x higher likelihood of white beneficiaries initiating encounters for the purpose of receiving vaccination.
  
  
  CONCLUSIONS
  Disparities in access to care and provider discrimination play little role in explaining racial/ethnic disparities in influenza vaccination. Eliminating missed opportunities for vaccination in 1995 would have raised vaccination rates in three racial/ethnic groups to the Healthy People 2000 goal of 60 percent vaccination.
authors.affiliation: Mount Sinai School of Medicine, Department of Health Policy, New York, NY, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Hebert
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kane
authors.forename: A Marshall
authors.initials: AM
authors.lastname: McBean
mesh_terms: D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003466:Cultural Characteristics; D018864:Cultural Diversity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D040361:Healthy People Programs; D006630:Hispanic or Latino / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000208:ethnology* / Q000517:prevention & control*; D008297:Male; D008913:Minority Groups / Q000523:psychology / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines