Racial/Ethnic Differences in Receipt of Influenza and Pneumococcal Vaccination Among Long-Stay Nursing Home Residents

Published in: Health Services Research [Epub August 2017]. doi: 10.1111/1475-6773.12759

Posted on RAND.org on September 15, 2017

by Jasmine L. Travers, Andrew W. Dick, Patricia Stone

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Objective/Study Question

To examine racial/ethnic differences in influenza and pneumococcal vaccination receipt and nonreceipt among nursing home (NH) residents post implementation of federal vaccination policy.

Data Sources / Study Setting / Study Design / Data Collection / Extraction Methods

An analysis of a merged national cross-sectional dataset containing resident assessment, facility, and community data for years 2010–2013 was conducted. Logistic regressions omitting and including facility fixed effects were used to examine the influence of race and ethnicity (black, Hispanic, white) and black concentration on vaccination status across and within NHs.

Principal Findings

Vaccination receipt of 107,874 residents in 742 NHs was examined. Blacks were less likely than whites to receive influenza and pneumococcal vaccinations (OR = 0.75; OR = 0.81, respectively, p-values <.001). The likelihood of not being offered the influenza vaccination was greater for blacks (OR=1.25, p = .004) and the likelihood of not being offered the pneumococcal vaccination was greater for Hispanics (OR = 1.65, p = .04) compared to whites. Fixed effects showed that within the same NH, Hispanics were more likely to receive both vaccinations compared to whites (OR=1.22, p = .004 (influenza); OR=1.34, p < .001 (pneumococcal)). Facilities highly concentrated with blacks accounted for large proportions of differences seen in vaccination receipt.


Racial/ethnic differences remain despite policy changes. Focused strategies aimed at NH personnel and racially segregated NHs are critical to improving vaccination delivery and eliminating disparities in care.

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