title: Disparities in pneumococcal and influenza immunization among older adults in Israel: a cross-sectional analysis of socio-demographic barriers to vaccination.
abstract: OBJECTIVE
  Vaccinations against influenza and pneumonia reduce morbidity and mortality among older adults. We examined vaccination rates among Israel's diverse geriatric population to determine socio-demographic barriers to vaccination.
  
  
  METHODS
  This study is a quantitative data analysis with a cross-sectional design, comprising 136,944 patients aged 65 and older enrolled during 2008-2009 in the Maccabi Healthcare Services, one of Israel's four sick funds (preferred provider organizations). We conducted multivariable logistic regression analyses to determine the association between vaccination status and socio-demographic characteristics, including age, gender, rural residency, socio-economic status, region of origin, immigrant status, and Holocaust survivorship. We controlled for potential confounders, including comorbidities, primary care visits and hospitalizations, as well as the physician's gender and region of origin.
  
  
  RESULTS
  Overall, vaccination rates were 72% for pneumonia and 59% for influenza. The strongest socio-demographic barriers to vaccination included female gender, rural residency, low socio-economic status, recent immigration, and being from or having a physician from the Former Soviet Union.
  
  
  CONCLUSIONS
  Efforts to further explore barriers to influenza and pneumococcal vaccination and interventions to reduce disparities in vaccination rates should focus on the sub-groups identified in this paper, with careful thought being given as to how to overcome these barriers.
authors: Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA. awschwartz@partners.org
authors: Andrea
authors: A
authors: Wershof Schwartz
authors: A Mark
authors: AM
authors: Clarfield
authors: John T
authors: JT
authors: Doucette
authors: Liora
authors: L
authors: Valinsky
authors: Tomas
authors: T
authors: Karpati
authors: Philip J
authors: PJ
authors: Landrigan
authors: Shelley A
authors: SA
authors: Sternberg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D007557:Israel / Q000453:epidemiology; D008297:Male; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*
chemical_list: D007252:Influenza Vaccines; D022242:Pneumococcal Vaccines