title: Racial inequities in receipt of influenza vaccination among nursing home residents in the United States, 2008-2009: a pattern of low overall coverage in facilities in which most residents are black.
abstract: OBJECTIVE
  Nationwide among nursing home residents, receipt of the influenza vaccine is 8 to 9 percentage points lower among blacks than among whites. The objective of this study was to determine if the national inequity in vaccination is because of the characteristics of facilities and/or residents.
  
  
  METHODS
  Cross-sectional study with multilevel modeling.
  
  
  METHODS
  States in which 1% or more of nursing home residents were black and the difference in influenza vaccination coverage between white and black nursing home residents was 1 percentage point or higher (n = 39 states and the District of Columbia). Data on residents (n = 2,359,321) were obtained from the Centers for Medicare & Medicaid Service's Minimum Data Set for October 1, 2008, through March 31, 2009.
  
  
  METHODS
  Residents' influenza vaccination status (vaccinated, refused vaccine, or not offered vaccination).
  
  
  RESULTS
  States with higher overall influenza vaccination coverage among nursing home residents had smaller racial inequities. In nursing homes with higher proportions of black residents, vaccination coverage was lower for both blacks and whites. The most dramatic inequities existed between whites in nursing homes with 0% blacks (L1) and blacks in nursing homes with 50% or more blacks (L5) in states with overall racial inequities of 10 percentage points or more. In these states, more black nursing home residents lived in nursing homes with 50% or more blacks (L5); in general, the same homes with low overall coverage.
  
  
  CONCLUSIONS
  Inequities in influenza vaccination coverage among nursing home residents are largely because of low vaccination coverage in nursing homes with a high proportion of black residents. Findings indicate that implementation of culturally appropriate interventions to increase vaccination in facilities with larger proportions of black residents may reduce the racial gap in influenza vaccination as well as increase overall state-level vaccination.
authors.affiliation: Health Services Research and Evaluation Branch, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA. BBardenheier@cdc.gov
authors.forename: Barbara
authors.initials: B
authors.lastname: Bardenheier
authors.forename: Pascale
authors.initials: P
authors.lastname: Wortley
authors.forename: Abigail
authors.initials: A
authors.lastname: Shefer
authors.forename: Mary Mason
authors.initials: MM
authors.lastname: McCauley
authors.forename: Stefan
authors.initials: S
authors.lastname: Gravenstein
mesh_terms: D001741:Black or African American; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D007252:Influenza Vaccines / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D008297:Male; D009735:Nursing Homes; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D007252:Influenza Vaccines