Factors Associated With Influenza Vaccination in a National Veteran Cohort
Alissa S. Chen, MD,
Melissa M. Farmer, PhD,
Ling Han, MD, PhD, MS,
Tessa Runels, MPH,
Brett Bade, MD,
Kristina Crothers, MD,
Lori A. Bastian, MD, MPH,
Isabel S. Bazan, MD,
Bevanne A. Bean-Mayberry, MD, MHS,
Cynthia A. Brandt, MD, MPH,
Kathleen M. Akgün, MD, MS
Affiliations
Alissa S. Chen, MD
Section of General Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut; Address correspondence to: Alissa S. Chen, MD, MPH, Department of Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven CT 06510.
Melissa M. Farmer, PhD
Center for Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
Ling Han, MD, PhD, MS
Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
Tessa Runels, MPH
Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
Brett Bade, MD
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Kristina Crothers, MD
VA Puget Sound, Seattle, Washington; Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington
Lori A. Bastian, MD, MPH
Section of General Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut; Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut
Isabel S. Bazan, MD
Pulmonary, Critical Care, & Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
Bevanne A. Bean-Mayberry, MD, MHS
Center for Study of Healthcare Innovation, Implementation, and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Cynthia A. Brandt, MD, MPH
Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut; Section of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut
Kathleen M. Akgün, MD, MS
Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut; Pulmonary, Critical Care, & Sleep Medicine, Yale University School of Medicine, New Haven, Connecticut
Introduction: Only 53% of American adults receive influenza vaccination, and disparities in vaccination exist among particular racial and ethnic groups. This study determines how race, ethnicity, sex, and rurality are associated with influenza vaccination adherence in a national Veteran Health Affairs Administration cohort. Methods: The authors examined differences in documented influenza vaccinations for the 2019–2020 influenza season among Veteran Health Affairs Administration patients in a retrospective cohort study using Veteran Health Affairs Administration administrative electronic health record data. The author used logistic regression to model receipt of influenza vaccination in association with race, ethnicity, sex, and rurality while controlling for clinical diagnoses, demographics, and ambulatory care utilization. The authors also stratified the models by sex and rurality. Results: Among 5,943,918 veterans, 48.6% received influenza vaccination. Unadjusted comparisons showed that those who were vaccinated were more likely to be White, to be of male sex, and to be older. Similar proportions of unvaccinated and unvaccinated veterans were from rural settings. In adjusted models, Black race was most strongly associated with decreased vaccination (AOR=0.69; 95% CI=0.69, 0.70), and American Indian/Alaskan Native race also had reduced odds of vaccination (AOR=0.94; 95% CI=0.92, 0.95) compared with White race. Female veterans had increased odds of vaccination (AOR=1.20; 95% CI=1.19, 1.20) compared with men. Rurality (AOR=0.97; 95% CI=0.96, 0.97) was associated with a small decreased odds of vaccination compared with urban. In stratified models, Black veterans were less likely to receive influenza vaccination regardless of sex and rurality than White veterans. American Indian/Alaska Native female veterans had equal odds of vaccination as White female veterans, whereas American Indian/Alaska Native male veterans had reduced odds of vaccination compared with White male veterans. Conclusions: During the 2019–2020 influenza season, Black and American Indian/Alaskan Native veterans had lower odds of vaccination. Despite the Veteran Health Affairs Administration's universal approach to healthcare, racial disparities still exist in preventive care.
