title: Disparities in influenza vaccination across the United States: Variability by minority group, Asian sub-populations, socio-economic status, and health insurance coverage.
abstract: OBJECTIVE
  The aim of this study is to examine the effects of ethnicity, disaggregating Asian Indian from other Asians, health insurance coverage, and nativity on influenza vaccination rates in the United States.
  
  
  METHODS
  National Health Interview Survey data (2013), collected by the National Center for Health Statistics, were analysed.
  
  
  METHODS
  Multivariable regression models were used to compute estimates and 95% confidence intervals.
  
  
  RESULTS
  Asian Indians had higher proportions of college graduate rates (mean = 0.85; CI = [0.80, 0.90]) and above-average income (mean = 0.56, CI = [0.48, 0.64]) than both Whites (mean = 0.406; CI = [0.39, 0.42]) and other Asian sub-groups, such as Chinese (mean = 0.544; CI = [0.47, 0.62]) and Filipino Americans (mean = 0.419; CI = [0.35, 0.48]). However, this higher socio-economic status did not uniformly translated into higher vaccine uptake rates. Asian Indian influenza vaccine uptake rate (mean = 0.403; CI = [0.33, 0.47]), while higher than Whites (mean = 0.366; CI = [0.36, 0.38]), were lower than Chinese (mean = 0.435; CI = [0.35, 0.52]) and Filipino Americans (mean = 0.431; CI = [0.37. 0.49]). In regression models, although Asian Indians were significantly more likely to receive the influenza vaccine than White Americans before controlling for health insurance status (OR = 1.38; CI = [1.004, 1.899]), when coverage was included, effects of race and ethnicity were eliminated (OR = 1.24; CI = [0.897, 1.705]).
  
  
  CONCLUSIONS
  Health disparities research often analyses Asians as a homogenous mass; however, the availability of disaggregated data allows researchers to parse effects leading to nuanced findings which highlight behavioural diversity within groups. Findings may inform the development of targeted interventions by public health practitioners and adjustments to polices designed to improve health insurance coverage in racial and ethnic minorities, regardless of citizenship status, leading to enhanced population health.
authors.affiliation: University of Alabama at Birmingham, Department of Health Care Organization and Policy and African American Studies, 517D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, USA. Electronic address: budhwani@uab.edu.
authors.forename: H
authors.initials: H
authors.lastname: Budhwani
authors.affiliation: Department of Economics and Business, The Colin Powell School for Civic and Global Leadership, The City College of City University of New York, 160 Convent Avenue, New York, NY 10031, USA. Electronic address: pde@ccny.cuny.edu.
authors.forename: P
authors.initials: P
authors.lastname: De
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D012923:Social Class; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D007252:Influenza Vaccines
keywords: Asian Indian; Health disparities; Influenza; Minority health; Vaccine