title: Understanding the reasons for the underuse of pneumococcal vaccination by community-dwelling older African Americans.
abstract: OBJECTIVE
  To understand the potential roles of various patient and provider factors in the underuse of pneumococcal vaccination in Medicare-eligible older African Americans.
  
  
  METHODS
  The Cardiovascular Health Study.
  
  
  METHODS
  Four U.S. states.
  
  
  METHODS
  Seven hundred ninety-five pairs of community-dwelling Medicare-eligible African-American and white adults aged 65 and older, balanced according to age and sex.
  
  
  METHODS
  Data on self-reported race, receipt of pneumococcal vaccination, and other important sociodemographic and clinical variables were collected at baseline.
  
  
  RESULTS
  Participants had a mean age ± standard deviation of 73 ± 6; 63% were female. Pneumococcal vaccination rates were 22% for African Americans and 28% for whites (unadjusted odds ratios (OR) for African Americans=0.75; 95% confidence interval (CI)=0.60-0.94; P=.01). This association remained significant despite adjustment for sociodemographic and clinical confounders, including education, income, chronic obstructive pulmonary disease, and prior pneumonia (OR=0.74, 95% CI=0.56-0.97; P=.03), but the association was no longer significant after additional adjustment for the receipt of influenza vaccination (OR=0.79, 95% CI=0.59-1.06; P=.12). Receipt of influenza vaccination was associated with higher odds of receiving pneumococcal vaccination (unadjusted OR=6.43, 95% CI=5.00-8.28; P<.001), and the association between race and pneumococcal vaccination lost significance when adjusted for influenza vaccination alone (OR=0.81, 95% CI=0.63-1.03; P=.09).
  
  
  CONCLUSIONS
  The strong association between receipt of influenza and pneumococcal vaccinations suggests that patient and provider attitudes toward vaccination, rather than traditional confounders such as education and income, may help explain the underuse of pneumococcal vaccination in older African Americans.
authors.affiliation: Section of Geriatrics and Extended Care, Veterans Affairs Medical Center, Birmingham, Alabama, USA.
authors.forename: Linda G
authors.initials: LG
authors.lastname: Jones
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Ahmed
authors.forename: O James
authors.initials: OJ
authors.lastname: Ekundayo
authors.forename: Shamima
authors.initials: S
authors.lastname: Akhter
authors.forename: Patricia
authors.initials: P
authors.lastname: Sawyer
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Aban
authors.forename: Richard V
authors.initials: RV
authors.lastname: Sims
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017589:Immunization Programs; D007252:Influenza Vaccines / Q000008:administration & dosage; D007251:Influenza, Human / Q000517:prevention & control; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D018410:Pneumonia, Bacterial / Q000208:ethnology / Q000517:prevention & control*; D012111:Residence Characteristics; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014611:Vaccination / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines