Regional Disparities in the Uptake of Differentiated Influenza Vaccines  in the United States

AbstractSignificant racial/ethnic inequities in the uptake of differentiated influenza vaccines (DIVs) have been previously reported, though less is known about regional disparities. We conducted a retrospective longitudinal study (2014/15 –2017/18 influenza seasons) among privately insured adults aged 65 + years in the US. The exposure was the beneficiary’s area of residence (US Census Bureau division) and the outcome was the type of influenza vaccine: differentiated (high-dose [HDV], adjuvanted, recombinant, and cell-based) versus conventional standard-dose egg-based. Multilevel logistic regression modeling, guided by a causal diagram, was used to assess the influence of socio-demographics, medical, healthcare utilization, community, and vaccinator characteristics in confounding or mediating regional disparities. Amon g those vaccinated in physician offices, beneficiaries in the East North Central region were twice as likely to receive a DIV vs those in the South Atlantic, whereas those in the East and West South Central were least likely. Disparities became more pronounced in models adjusted for individual and c ommunity characteristics, suggesting that crude uptake estimates understate the true magnitude of disparities. A vaccinator’s previous HDV use was most influential in explaining regional differences. Similar but less pronounced patterns emerged for vaccinations in pharmacies/facilities. Regional d isparities remained even in fully adjusted models, pointi...
Source: Journal of Racial and Ethnic Health Disparities - Category: International Medicine & Public Health Source Type: research