Impact of influenza vaccination disparities on elderly mortality in the United States
Introduction
Influenza is a major cause of preventable morbidity and mortality in the United States accounting for roughly 50,000 deaths annually (Thompson et al., 2003). Ninety percent of these deaths occur among the elderly and most are cardiovascular related (Thompson et al., 2003). Influenza vaccination appears to reduce all-cause mortality (Jefferson et al., 2005, Rivetti et al., 2006). Yet, African Americans and Hispanics consistently report lower rates of influenza vaccination than non-Hispanic whites. In 2004, only 46% of elderly African Americans and 55% of Hispanics reported receiving the vaccine compared to 67% of non-Hispanic whites (National Center for Health Statistics, 2005). The impact of disparity in receipt of influenza vaccination by race and ethnicity on minority deaths is not known.
In this study, we estimate the number of annual deaths that would be reduced if influenza vaccination parity were achieved between African American, Hispanic, and white non-Hispanic Medicare enrollees 65 years and older. We also estimate the impact of attainment of 90% vaccination rates (Healthy People 2010 objective) on annual deaths among elderly persons from each group and years of life saved from parity in vaccination beginning at age 65.
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Effect on mortality
We use U.S. census population projections (U.S. Census Bureau, 2005) to determine the number of elderly minority persons and use 2002 annual deaths stratified by age, sex, race and ethnicity for base mortality rates (Kochanek and Smith, 2004).
We derive contemporary vaccination rates for community dwelling and institutionalized African Americans, Hispanics and non-Hispanic whites from the Medicare Current Beneficiary Survey (MCBS) for 2002. The MCBS is a national survey of roughly 15,000
Results
According to U.S. Census data, there were nearly 3 million African Americans and more than 2 million Hispanic Americans respectively, 65 and older, residing in the United States in 2002 (Table 1) (U.S. Census Bureau, 2005). The total number of annual deaths and influenza-related annual deaths for each group are also shown in Table 1. Based on the proportion of deaths attributable to influenza, we estimate that more than 5000 African American and more than 2000 Hispanic deaths are influenza
Discussion
Racial and ethnic disparities in health care have been extensively documented (Institute of Medicine, 2002), but few if any, studies have estimated the impact of these disparities on mortality. Using a combination of vaccination rates derived from the MCBS and conservative estimates of influenza vaccine efficacy from published data, we model the impact of racial and ethnic disparities in influenza vaccination rates on elderly African American and Hispanic deaths. Findings suggest that
Conclusion
In conclusion, racial and ethnic disparities in influenza vaccination contribute appreciably to elderly minority mortality. Achievement of the Healthy People 2010 influenza objective for all should become a national priority.
Acknowledgment
Funding: Robert Wood Johnson Foundation.
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