Jan 24, 2011
Published in: Archives of Internal Medicine, v. 171, no. 2, Jan. 24 2011, p. 158-165
Posted on RAND.org on January 23, 2011
BACKGROUND: Seasonal influenza and pneumococcal immunization rates are substantially lower for older Hispanics than for non-Hispanic whites. METHODS: Beneficiary-reported past-year influenza and lifetime pneumococcal immunization for English- and Spanish-preferring Hispanic beneficiaries were compared with those for non-Hispanic whites in cross-sectional bilingual survey data using data from 244 618 randomly sampled community-dwelling respondents (age 65 years) with the 2008 Medicare Consumer Assessment of Healthcare Providers and Systems survey (a 62% response rate). Weighted logistic regression estimated immunization disparities with and without adjustment for health status, sociodemographic variables related to access, and location. Hierarchical models examined the role of specific geographic factors in immunization disparities. RESULTS: Pneumococcal immunization rates for Spanish- and English-speaking Hispanics were substantially lower than those for non-Hispanic whites (40% and 56% vs 74%; P < .001 for both comparisons). Influenza immunization rates for Spanish- and English-speaking Hispanics were also lower than for non-Hispanic whites (64% and 68% vs 76%; P < .001 for both comparisons). Health status-adjusted differences were similar; additional adjustment for sociodemographics reduced pneumococcal disparities by approximately one-third and influenza disparities by approximately half, but all disparities remained significant. Pneumococcal disparities were consistently smaller for patients in managed care plans. Influenza disparities were greater both in linguistically isolated areas and in "new destination" areas without long-standing Hispanic populations. CONCLUSIONS: Hispanic seniors, especially when Spanish-preferring and in linguistically isolated "new destinations," such as the Southeast, continue to be immunized at markedly lower rates than non-Hispanic whites, even after adjustment for health and sociodemographics. Individual physicians and policymakers may be able to assist this vulnerable group by addressing cultural and linguistic barriers to immunization.