title: Racial/ethnic differences in influenza vaccination in the Veterans Affairs Healthcare System.
abstract: BACKGROUND
  Racial/ethnic differences in influenza vaccination exist among elderly adults despite nearly universal Medicare health insurance coverage. Overall influenza vaccination prevalence in the Veterans Affairs (VA) Healthcare System is higher than in the general population; however, it is not known whether racial/ethnic differences exist among older adults receiving VA healthcare. Racial/ethnic differences in influenza vaccination in VA were assessed, and barriers to and facilitators of influenza vaccination were examined among veteran outpatients aged 50 years and older.
  
  
  METHODS
  A random sample of 121,738 veterans receiving care at VA outpatient clinics during the 2003-2004 influenza season completed the mailed Survey of Health Experiences of Patients (77% response rate). Multivariate logistic regression was used to examine associations among race/ethnicity and influenza vaccination prevalence, barriers, and facilitators. Analyses were conducted during 2005 and 2006.
  
  
  RESULTS
  Based on unadjusted prevalences, non-Hispanic blacks, Hispanics, and American Indian/Alaskan Natives were significantly less likely to be vaccinated for influenza compared to non-Hispanic whites (71%, 79%, and 74%, respectively, vs 82%). After adjustment for age, gender, marital status, education level, employment, having a primary care provider, confidence and/trust in provider, and health status, only non-Hispanic blacks remained significantly less likely to be vaccinated compared to non-Hispanic whites (75% vs 81%). Influenza vaccination barriers and facilitators varied by race/ethnic group.
  
  
  CONCLUSIONS
  Compared to non-Hispanic whites, non-Hispanic blacks were less likely to receive influenza vaccination in the VA healthcare system during the 2003-2004 influenza season. Although these differences were small, results suggest the need for further study and culturally informed interventions.
authors.affiliation: Veterans Affairs National Center for Health Promotion and Disease Prevention-NCP, Durham, North Carolina 27705, USA. straits-troster@biac.duke.edu
authors.forename: Kristy A
authors.initials: KA
authors.lastname: Straits-Tröster
authors.forename: Leila C
authors.initials: LC
authors.lastname: Kahwati
authors.forename: Linda S
authors.initials: LS
authors.lastname: Kinsinger
authors.forename: Jean
authors.initials: J
authors.lastname: Orelien
authors.forename: Mary B
authors.initials: MB
authors.lastname: Burdick
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Yevich
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007198:Indians, North American / Q000706:statistics & numerical data; D009980:Influenza A virus / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000208:ethnology* / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines