title: Factors associated with vaccination of medicare beneficiaries in five U.S. communities: Results from the racial and ethnic adult disparities in immunization initiative survey, 2003.
abstract: OBJECTIVE
  To examine vaccination in seniors in the five U.S. communities of the Racial and Ethnic Adult Disparities in Immunization Initiative.
  
  
  METHODS
  Cross-sectional telephone survey in spring 2003 using stratified sampling by ZIP code and race/ethnicity.
  
  
  METHODS
  New York, Texas, Wisconsin, Illinois, and Mississippi.
  
  
  METHODS
  Four thousand five hundred seventy-seven Medicare beneficiaries.
  
  
  METHODS
  Outcomes were pneumococcal vaccination ever and influenza vaccination in 2002/03 and were determined according to race/ethnicity, awareness of vaccination, and provider recommendation. Survey questions also asked about future plans for vaccination, whether respondents believed they had become sick from prior influenza vaccination, and whether unvaccinated respondents would be vaccinated if a health professional recommended it.
  
  
  RESULTS
  Pneumococcal vaccination coverage was 70.3% for whites, 40.8% for blacks, and 53.2% for Hispanics, and the proportion reporting provider recommendation for vaccination differed significantly according to race/ethnicity. In multivariate regression, provider recommendation (risk ratio (RR) = 2.32, 95% confidence intervals (CI) = 2.10-2.57) and awareness of vaccination (RR = 1.60, 95% CI = 1.40-1.82) were associated with greater pneumococcal vaccination. Influenza vaccination coverage was 76.2% for whites, 50.7% for blacks, and 65.7% for Hispanics. A little more than half of respondents reported provider recommendation for influenza vaccination, with no differences according to race/ethnicity. Provider recommendation was associated with influenza vaccination (RR = 1.31, 95% CI = 1.25-1.38). More blacks and Hispanics believed they had become sick from prior influenza vaccination than whites, and this belief was associated with lower vaccination rates.
  
  
  CONCLUSIONS
  This survey details vaccination patterns in an ethnically and geographically diverse sample of seniors and identifies some differences between blacks, Hispanics, and whites that may contribute to disparities in vaccination coverage. Survey findings highlight the importance of provider vaccination recommendations.
authors.affiliation: Health Services Research and Evaluation Branch, Immunization Services Division, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. cwinston@cdc.gov
authors.forename: Carla A
authors.initials: CA
authors.lastname: Winston
authors.forename: Pascale M
authors.initials: PM
authors.lastname: Wortley
authors.forename: Karen A
authors.initials: KA
authors.lastname: Lees
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000208:ethnology / Q000517:prevention & control*; D008297:Male; D006278:Medicare / Q000191:economics*; D010342:Patient Acceptance of Health Care; D011008:Pneumococcal Infections / Q000208:ethnology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011159:Population Surveillance; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000191:economics*; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines