Factors contributing to racial disparities in influenza vaccinations
Factors contributing to racial disparities in influenza vaccinations
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DOI：
10.1371/journal.pone.0213972
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发表时间：
2019-04-03
期刊：
影响因子：
3.7
通讯作者：
Horberg, Michael A.
中科院分区：
文献类型：
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作者：
Vupputuri, Suma;Rubenstein, Kevin B.;Horberg, Michael A.
背景在美国，流感疫苗接种率的种族/种族差异仍然是一个问题，即使在那些有机会、没有自付费用的人中，并在对混杂因素进行调整后也是一个问题。我们使用一种称为Oaxaca-Blinder(OB)分解法的方法来确定协变量单独和总体对流感疫苗接种的种族差异的贡献。方法我们纳入了截至2014年5月1日年龄=18岁的成员，并持续登记到2015年4月30日。流感疫苗接种是通过诊断、程序或药物代码或免疫表中的文件来定义的。特征是按种族报告的。Logistic回归模型估计接种疫苗的几率与以下因素有关：(1)种族；(2)按种族分层的协变量。OB(Oaxaca-Blinder)方法计算协变量对黑人和白人接种疫苗差异的贡献。结果我们发现，在成年人中，44%的人接种过疫苗，55%的人是黑人，45%的人是白人。黑人会员接种疫苗的几率比白人会员低42%。黑人和白人成员之间研究协变量平均值的差异(OB协变量效应)的贡献占种族差异的29%。在疫苗接种方面，白人和黑人的总体差异包括：年龄(16%)、社区收入中位数(11%)和在线患者门户网站上的注册(13%)。协变量对疫苗接种的影响差异(OB系数效应)可以解释黑人和白人接种流感疫苗的差异的71%。结论总体来说，使黑人和白人的平均协变量值相等可以将流感疫苗接种的种族差异缩小29%。对于卫生系统疫苗运动，改善患者门户上的登记可能是减少疫苗接种中种族差异的有效系统一级战略的一个目标组成部分。关于以患者为中心的因素的更多信息可能会进一步提高OB方法的价值。
BackgroundRacial/ethnic disparities in rates of influenza vaccinations in the US remain an issue even among those with access, no out-of-pocket costs, and after adjusting for confounders. We used an approach called the Oaxaca-Blinder (OB) decomposition method to ascertain the contribution of covariates individually and in aggregate to the racial disparity in influenza vaccination.MethodsWe included members > = 18 years of age as of 05/01/2014 with continuous enrollment through 04/30/2015. Influenza vaccination was defined by diagnosis, procedure, or medication codes, or documentation in the immunization table. Characteristics were reported by race. Logistic regression models estimated the odds of vaccination associated with: (1) race; and (2) covariates stratified by race. The Oaxaca-Blinder (OB) method calculated the contribution of covariates to the difference or disparity in vaccination between Blacks and Whites.ResultsWe found that among adults, 44% were vaccinated; 55% were Black; and 45% were White. Black members have 42% lower odds of vaccination than White members. The contribution of the differences in the average value of the study covariates between Black and White members (the OB covariate effect) accounted for 29% of the racial disparity. The contributions to the total White-Black disparity in vaccination included: age (16%), neighborhood median income (11%), and registration on the online patient portal (13%). The contribution of the differences in how the covariates impact vaccination (OB coefficient effect) accounted for 71% of the disparity in vaccination between Blacks and Whites.ConclusionIn conclusion, equalizing average covariate values in Blacks and Whites could reduce the racial disparity in influenza vaccination by 29%. For health system vaccine campaigns, improving registration on the patient portal may be a target component of an effective system-level strategy to reduce racial disparities in vaccination. Additional information on patient-centered factors could further improve the value of the OB approach.