Racial inequities in receipt of influenza vaccination among long-term care residents within and between facilities in Michigan

Abstract

Background: Although influenza vaccination is recommended for all nursing home residents and is covered by Medicare, racial inequities remain.

Objectives: To determine the extent of racial difference in influenza vaccination among nursing home residents within and between nursing facilities by facility resident racial composition in a state with a large White-Black difference in vaccination.

Research design: Data from the Centers for Medicaid & Medicare Services' (CMS) Minimum Data Set (MDS) for assessments from October 1, 2005 through March 31, 2006. Facility-level data for nonhospital-administered CMS-certified nursing facilities in Michigan were merged with MDS.

Subjects: All nursing home residents (n=90,120).

Main outcome measure: Receipt, refusal, or unvaccinated due to contraindication or not being offered the influenza vaccine.

Results: The unadjusted influenza vaccination coverage of residents was 60.6%, 63.5% for whites, and 43.0% for blacks, a difference of 20.5 percentage points. The adjusted median range of inequity (white-black) within homes stratified by proportion blacks in the facility (eg, 0%, 1% to 4.9%, 5% to 19.9%, 20% to 49.9%, and ≥50%) was 5.0% to 5.6% points. White residents refused the vaccine less than black residents in all groups of homes by proportion blacks in the home, ranging from 7.6% [corrected] in the all white homes to 14.3% [corrected] among blacks in homes with >50% black residents. The adjusted median black deficit in not being offered the vaccine between nursing homes was large (up to 26.0% [corrected] points between all white homes and homes with >50% blacks).

Conclusion: Michigan statewide vaccination inequity among nursing home residents results from blacks disproportionately living in nursing homes where vaccination coverage is lowest. The inequity between facilities can be attributed to facility-level difference in offering.