S-EPMC7489417 - Sociodemographic Disparities in Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease in the United States. - OmicsDI

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Dataset Information

Sociodemographic Disparities in Influenza Vaccination Among Adults With Atherosclerotic Cardiovascular Disease in the United States.

ABSTRACT:

Importance

Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of death and disability in the US and worldwide. Influenza vaccination has shown to decrease overall morbidity, mortality, severity of infection, and hospital readmissions among these individuals. However, national estimates of influenza vaccination among individuals with ASCVD in the US are not well studied.

Objective

To evaluate the prevalence of and sociodemographic disparities in influenza vaccination among a nationally representative sample of individuals with ASCVD.

Design, setting, and participants

Pooled Medical Expenditure Panel Survey data from 2008 to 2016 were used and included adults 40 years or older with ASCVD. Participants' ASCVD status was ascertained via self-report and/or International Classification of Diseases, Ninth Revision diagnosis of coronary heart disease, peripheral artery disease, and/or cerebrovascular disease. Analysis began April 2020.

Main outcomes and measures

Prevalence and characteristics of adults with ASCVD who lacked influenza vaccination during the past year. Covariates including age, sex, race/ethnicity, family income, insurance status, education level, and usual source of care were assessed.

Results

Of 131 881 adults, 19 793 (15.7%) had ASCVD, corresponding to 22.8 million US adults annually. A total of 7028 adults with ASCVD (32.7%), representing 7.4 million adults, lacked influenza vaccination. The highest odds of lacking vaccination were observed among individuals aged 40 to 64 years (odds ratio [OR], 2.32; 95% CI, 2.06-2.62), without a usual source of care (OR, 2.00; 95% CI, 1.71-2.33), without insurance (OR, 2.05; 95% CI, 1.63-2.58), with a lower education level (OR, 1. 25; 95% CI, 1.12-1.40), with a lower income level (OR, 1.14; 95% CI, 1.01-1.27), and of non-Hispanic Black race/ethnicity (OR, 1.24, 95% CI, 1.10-1.41). A stepwise increase was found in the prevalence and odds of lacking influenza vaccination among individuals with increase in high-risk characteristics. Overall, 1171 individuals (59.7%; 95% CI, 55.8%-63.5%) with 4 or more high-risk characteristics and ASCVD (representing 732 524 US adults annually) reported lack of influenza vaccination (OR, 6.06; 95% CI, 4.88-7.53).

Conclusion and relevance

Despite current recommendations, a large proportion of US adults with established ASCVD lack influenza vaccination, with several sociodemographic subgroups having greater risk. Focused public health initiatives are needed to increase access to influenza vaccinations for high-risk and underserved populations.

SUBMITTER: Grandhi GR

PROVIDER: S-EPMC7489417 | biostudies-literature |

REPOSITORIES: biostudies-literature

Similar Datasets

Project description:BackgroundPeople living with chronic health conditions exhibit higher risk for developing severe complications from influenza according to the Centers for Diseases Control and Prevention. Although racial and ethnic disparities in influenza vaccination have been documented, it has not been comprehensively determined whether similar disparities are present among the adult population with at least one such condition.ObjectiveTo study if racial and ethnic disparities in relation to influenza vaccination are present in adults suffering from at least one chronic condition and if such inequalities differ between age groups.MethodsThe Medical Expenditure Panel Survey (2011-2012) was used to study the adult population (age ?18) who had at least one chronic health condition. Baseline differences in population traits across racial and ethnic groups were identified using a chi-square test. This was conducted among various age groups. In addition, survey logistic regression was utilized to produce odds ratios of receiving influenza vaccination annually between racial and ethnic groups.ResultsThe total sample consisted of 15,499 adults living with at least one chronic health condition. The numbers of non-Hispanic whites (whites), non-Hispanic blacks (blacks), and Hispanics were 8,658, 3,585, and 3,256, respectively. Whites (59.93%) were found to have a higher likelihood of self-reporting their receipt of the influenza vaccine in comparison to the black (48.54%) and Hispanic (48.65%) groups (P<0.001). When examining persons aged 50-64 years and ?65 years, it was noted that the black (54.99%, 62.72%) and Hispanic (53.54%, 64.48%) population had lower rates of influenza vaccine coverage than the white population (59.22%, 77.89) (both P<0.0001). No significant differences between whites and the blacks or Hispanics were found among the groups among adults between 18 and 49 inclusive (P>0.05). After controlling for patient characteristics, the difference in influenza vaccine coverage between whites and the minority groups were no longer significant for adults aged 50-64 years. However, the difference were still statistically significant for those aged ?65 years.ConclusionsIn the United States, there are significant disparities in influenza vaccination by race and ethnicity for adults over 65 years with at least one chronic health condition. Future research is needed to help develop more targeted interventions to address these issues and improve influenza vaccination rates.

Project description:IntroductionThe importance of receiving an annual influenza vaccine among patients with atherosclerotic cardiovascular disease (ASCVD) is well established. With the rapid community spread and the possibility of another wave of COVID-19 infections in the fall, receiving an influenza vaccine is of particular importance to mitigate the risk associated with overlapping influenza and COVID-19 infections.MethodsWe utilized cross-sectional data from the 2016 to 2019 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative U.S. telephone-based survey of adults 18 years or older. Race/ethnicity was our exposure of interest. We assessed the relative difference in influenza vaccination by race/ethnicity for each U.S. state in the overall U.S. population and among those with ASCVD as prevalence of receipt of influenza vaccination among Blacks or Hispanics minus prevalence among Whites divided by prevalence among Whites. We used multivariable-adjusted logistic regression models to evaluate the association between socioeconomic risk factors and receipt of influenza vaccination.ResultsThe study population consisted of 1,747,397 participants of whom 21% were older than 65 years, 51% women, 63% White, 12% Black, 17% Hispanic, and 9% with history of ASCVD. The receipt of influenza vaccine was 38% in the overall population and 51% among those with self-reported ASCVD, which translates to approximately to 97 million and 12 million US adults, respectively. The receipt of influenza vaccine among individuals with ASCVD was 54% for Whites, 45% for Blacks, and 42% for Hispanics (p<0.001). In the overall U.S. population, the median (interquartile range) relative difference for influenza vaccination between Blacks and Whites was 17% (-27%, -9%) and -22% (-29%, -9%) between Hispanics and Whites across all U.S. states. Among individuals with and without ASCVD, age older than 65 years, greater than college education, higher income, and having a primary care physician were significantly associated with higher odds of receipt of influenza vaccination, while being employed, lack of healthcare coverage, Black race, and delay in healthcare access were significantly inversely associated with having received an influenza vaccine.ConclusionsOnly 50% patients with ASCVD receive influenza vaccines. The receipt of influenza vaccination among individuals with ASCVD is lower among Blacks and Hispanics compared to Whites with significant state-level variation. There are important socioeconomic determinants that are associated with receipt of the influenza vaccine.

Project description:ObjectiveThe study objective is to analyze influenza vaccination status by demographic factors, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance status, and barriers to influenza vaccination among adults 18 years and older in the United States.BackgroundInfluenza vaccination coverage among adults 18 years and older was 41% during 2010-2011 and has increased and plateaued at 43% during 2016-2017. This is below the target of 70% influenza vaccination coverage among adults, which is an objective of the Healthy People 2020 initiative.MethodsWe conducted a survey of a nationally representative sample of adults 18 years and older in the United States on factors affecting influenza vaccination. We conducted bivariate analysis using Rao-Scott chi-square test and multivariate analysis using weighted multinomial logistic regression of this survey data to determine the effect of demographics, perceived vaccine efficacy, social influence, herd immunity, vaccine cost, health insurance, and barriers associated with influenza vaccination uptake among adults in the United States.ResultsInfluenza vaccination rates are relatively high among adults in older age groups (73.3% among 75 + year old), adults with education levels of bachelor's degree or higher (45.1%), non-Hispanic Whites (41.8%), adults with higher incomes (52.8% among adults with income of over $150,000), partnered adults (43.2%), non-working adults (46.2%), and adults with internet access (39.9%). Influenza vaccine is taken every year by 76% of adults who perceive that the vaccine is very effective, 64.2% of adults who are socially influenced by others, and 41.8% of adults with health insurance, while 72.3% of adults without health insurance never get vaccinated. Facilitators for adults getting vaccinated every year in comparison to only some years include older age, perception of high vaccine effectiveness, higher income and no out-of-pocket payments. Barriers for adults never getting vaccinated in comparison to only some years include lack of health insurance, disliking of shots, perception of low vaccine effectiveness, low perception of risk for influenza infection, and perception of risky side effects.ConclusionInfluenza vaccination rates among adults in the United States can be improved towards the Healthy People 2020 target of 70% by increasing awareness of the safety, efficacy and need for influenza vaccination, leveraging the practices and principles of commercial and social marketing to improve vaccine trust, confidence and acceptance, and lowering out-of-pocket expenses and covering influenza vaccination costs through health insurance.

Project description:ImportanceThere are limited data regarding sex-based differences in physical and mental health domains and health care access in adults with premature atherosclerotic cardiovascular disease (ASCVD).ObjectiveTo study the association of sex with physical and mental health domains as well as health care access-related factors among adults with self-reported premature ASCVD.Design, setting, and participantsRetrospective cohort analysis of 748 090 adults aged 18 to 55 years in the Behavioral Risk Factor Surveillance System 2016 to 2019 in the US. Data were analyzed from June to July 2021.ExposuresSelf-reported ASCVD, defined as having a history of coronary artery disease, myocardial infarction, or stroke.Main outcomes and measuresSelf-reported physical and mental health and measures of health care access, including self-reported cost-related medication nonadherence and inability to see a physician due to cost.ResultsBetween 2016 and 2019, 748 090 adults aged 18-55 years were identified, of whom 28 522 (3.3%) had self-reported premature ASCVD. Of these, 14 358 (47.0%) were women. Compared with men, women with premature ASCVD were more likely to report being clinically depressed (odds ratio [OR], 1.73; 95% CI, 1.41-2.14; P < .001), have cost-related medication nonadherence (OR, 1.42; 95% CI, 1.11-1.82; P = .005), have not seen a physician due to cost-related issues (OR, 4.52; 95% CI, 2.24-9.13; P < .001), and were more likely to report overall poor physical health (OR, 1.39; 95% CI, 1.09-1.78; P = .008) despite being more likely to have health care coverage (85.3% vs 80.8%; P = .04) and a primary care physician (84.2% vs 75.7%; P < .001).Conclusions and relevanceResults from this study indicate that women with premature ASCVD were more likely to report worse overall physical and mental health, inability to see a physician due to cost, and cost-related medical nonadherence. Interventions addressing mental health and out-of-pocket costs are needed in adults with premature ASCVD.