Flu Vaccination Rates Lower Among Minority Patients

John Danziger, MD

Seasonal influenza (flu) vaccination rates are lower among dialysis facilities with larger populations of minority patients, according to recent study findings.

Due to coronavirus disease 2019 (COVID-19) and the need for a wide-scale vaccination campaign, the findings highlighted which populations were at the greatest need for vaccination outreach programs. The disparities must be addressed to protect patients and communities equitably.

John Danziger, MD, and colleagues aimed to determine whether the proportion of patients vaccinated at a dialysis facility differed according to the facility’s racial and ethnic composition. To do this, the team analyzed data from Dialysis Facility Reports, the most recent of which reflected Medicare certified facilities operating in 2017 with data from 2014-2017 of Medicare patients. The reports included patients with Medicare as the primary payer and all vaccinations billed to Medicare.

Dialysis facilities reported the proportion of patients who were African American or Hispanic. Further, facilities reported characteristics including number of patients, commercial or nonprofit affiliation, average patient age, average patient years of prior end-stage renal disease therapy, average number of patient comorbidities, average percent of patients with serum phosphorus >7 mg/dL, and average fistula rate.

The investigators looked at the proportion of patients vaccinated for flu during peak season—August 1 to December 31. They assessed the association of calendar year with seasonal flu vaccination percentages and determined if the association differed by facility racial/ethnic composition

There were a total of 6735 Medicare certified dialysis facilities operating between 2014-2017. Facilities with larger proportions of African American and Hispanic patients were larger, nonprofit, and had older patients.

The mean percentage of patients vaccinated during flu season was 72.1%. In facilities with higher proportions of African American and Hispanic patients, there were lower seasonal vaccination percentages. When the team used patient racial/ethnic composition as a continuous variable, a 10% increment in proportion of patients who were African American was associated with a .6% (95% CI, -.74 to -.5; P <.001) lower percent vaccinated. Estimates for Hispanic patients was .79% (95% CI, -.95 to -.63; P <.001).

Seasonal flu vaccination decreased in reported prevalence 1.05% (95% CI, -1.19 to -.92; P <.001). The trend was most common among facilities with higher proportions of African American and Hispanic patients.

Facilities in the lowest quartile of African American patients saw a .82% (95% CI, -1.1 to -.53; P <.001) lower percent vaccinated per year compared to 1.21% (95% CI -1.5 to -.93; P <.001) lower percent vaccinated per year in facilities in the highest quartile. The investigators reported a similar trend across higher quartiles of Hispanic patients.

While medical vulnerability exists in patients with end-stage renal disease, seasonal flu vaccination was not universal and varied widely across US dialysis facilities. In fact, facilities did not vaccinate an average of approximately 25% of patients, but more so in facilities with larger proportions of African American and Hispanic patients.

The findings highlighted the need for a better understanding of the racial/ethnic disparities in vaccination, which are growing over time. This could protect those at more risk for complications of flu and other viral pathogens.

The study, “Racial and ethnic disparities in seasonal influenza vaccination rates among dialysis facilities in the United States,” was published online in the Journal of the American Society of Nephrology.