Racial Inequities in Receipt of Influenza Vaccination Among Long-term Care Residents Within and Between Facilities in Michigan
Racial Inequities in Receipt of Influenza Vaccination Among Long-term Care Residents Within and Between Facilities in Michigan
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DOI：
10.1097/mlr.0b013e3182054293
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发表时间：
2011-04-01
期刊：
影响因子：
3
通讯作者：
Hogue, Carol J. Rowland
中科院分区：
文献类型：
--
作者：
Bardenheier, Barbara;Wortley, Pascale;Hogue, Carol J. Rowland
背景资料：虽然流感疫苗接种是建议所有养老院居民和医疗保险覆盖，种族不平等remain.Objectives：为了确定流感疫苗接种的种族差异程度在养老院居民内和之间的护理设施设施居民的种族组成在一个国家与一个大的白人和黑人的疫苗接种差异。数据来自医疗补助和医疗保险服务中心（CMS）最小数据集（MDS），用于2005年10月1日至2006年3月31日的评估。密歇根州非医院管理的CMS认证的护理设施的设施级数据与MDS合并。（n = 90，120）。主要结果测量：接受、拒绝或由于禁忌症而未接种或未提供流感疫苗。未经调整的居民流感疫苗接种覆盖率为60.6%，白人为63.5%，黑人为43.0%，相差20.5个百分点。按设施中黑人比例（例如，0%、1%至4.9%、5%至19.9%、20%至49.9%和>= 50%）分层的家庭内不平等（白人-黑人）的调整后中位数范围为5.0%至5.6%。按家庭中黑人的比例计算，在所有家庭组中，白色居民拒绝接种疫苗的比例低于黑人居民，范围从所有白色家庭的7.5%到黑人居民> 50%的家庭中黑人的14.0%。调整后的中位数黑人赤字不提供的疫苗之间的养老院是大的（高达27.8%的点之间的所有白色家庭和家庭与> 50%的黑人）。结论：密歇根州全州范围内的疫苗接种不公平的养老院居民的结果，从黑人不成比例地生活在养老院的疫苗接种覆盖率最低。设施之间的不平等可以归因于设施级别的差异提供。
Background: Although influenza vaccination is recommended for all nursing home residents and is covered by Medicare, racial inequities remain.Objectives: To determine the extent of racial difference in influenza vaccination among nursing home residents within and between nursing facilities by facility resident racial composition in a state with a large White-Black difference in vaccination.Research Design: Data from the Centers for Medicaid & Medicare Services' (CMS) Minimum Data Set (MDS) for assessments from October 1, 2005 through March 31, 2006. Facility-level data for nonhospital-administered CMS-certified nursing facilities in Michigan were merged with MDS.Subjects: All nursing home residents (n = 90,120).Main Outcome Measure: Receipt, refusal, or unvaccinated due to contraindication or not being offered the influenza vaccine.Results: The unadjusted influenza vaccination coverage of residents was 60.6%, 63.5% for whites, and 43.0% for blacks, a difference of 20.5 percentage points. The adjusted median range of inequity (white-black) within homes stratified by proportion blacks in the facility (eg, 0%, 1% to 4.9%, 5% to 19.9%, 20% to 49.9%, and >= 50%) was 5.0% to 5.6% points. White residents refused the vaccine less than black residents in all groups of homes by proportion blacks in the home, ranging from 7.5% in the all white homes to 14.0% among blacks in homes with > 50% black residents. The adjusted median black deficit in not being offered the vaccine between nursing homes was large (up to 27.8% points between all white homes and homes with > 50% blacks).Conclusion: Michigan statewide vaccination inequity among nursing home residents results from blacks disproportionately living in nursing homes where vaccination coverage is lowest. The inequity between facilities can be attributed to facility-level difference in offering.