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Understanding the reasons for the underuse of pneumococcal vaccination by community-dwelling older African Americans

TitleUnderstanding the reasons for the underuse of pneumococcal vaccination by community-dwelling older African Americans
Publication TypeJournal Article
Year of Publication2010
AuthorsJones, LG, Zhang, Y, Ahmed, MI, Ekundayo, OJ, Akhter, S, Sawyer, P, Aban, I, Sims, RV, Ahmed, A
JournalJ Am Geriatr SocJ Am Geriatr Soc
Date PublishedDec
ISBN Number1532-5415 (Electronic)<br/>0002-8614 (Linking)
Accession Number21143440
KeywordsAfrican Americans/ statistics & numerical data, Aged, Cohort Studies, Confidence Intervals, European Continental Ancestry Group/ statistics & numerical data, Female, Health Knowledge, Attitudes, Practice, Humans, Immunization Programs, Influenza Vaccines/administration & dosage, Influenza, Human/prevention & control, Male, Medicare/statistics & numerical data, Odds Ratio, Patient Acceptance of Health Care/ ethnology, Pneumococcal Vaccines/ administration & dosage, Pneumonia, Bacterial/ethnology/ prevention & control, Questionnaires, Residence Characteristics, Risk Factors, United States/epidemiology, Vaccination/utilization
AbstractOBJECTIVES: To understand the potential roles of various patient and provider factors in the underuse of pneumococcal vaccination in Medicare-eligible older African Americans. DESIGN: The Cardiovascular Health Study. SETTING: Four U.S. states. PARTICIPANTS: Seven hundred ninety-five pairs of community-dwelling Medicare-eligible African-American and white adults aged 65 and older, balanced according to age and sex. MEASUREMENTS: Data on self-reported race, receipt of pneumococcal vaccination, and other important sociodemographic and clinical variables were collected at baseline. RESULTS: Participants had a mean age +/- standard deviation of 73 +/- 6; 63% were female. Pneumococcal vaccination rates were 22% for African Americans and 28% for whites (unadjusted odds ratios (OR) for African Americans=0.75; 95% confidence interval (CI)=0.60-0.94; P=.01). This association remained significant despite adjustment for sociodemographic and clinical confounders, including education, income, chronic obstructive pulmonary disease, and prior pneumonia (OR=0.74, 95% CI=0.56-0.97; P=.03), but the association was no longer significant after additional adjustment for the receipt of influenza vaccination (OR=0.79, 95% CI=0.59-1.06; P=.12). Receipt of influenza vaccination was associated with higher odds of receiving pneumococcal vaccination (unadjusted OR=6.43, 95% CI=5.00-8.28; P<.001 and="" the="" association="" between="" race="" pneumococcal="" vaccination="" lost="" significance="" when="" adjusted="" for="" influenza="" alone="" ci="0.63-1.03;" p=".09)." conclusion:="" strong="" receipt="" of="" vaccinations="" suggests="" that="" patient="" provider="" attitudes="" toward="" rather="" than="" traditional="" confounders="" such="" as="" education="" income="" may="" help="" explain="" underuse="" in="" older="" african="" americans.="">
Short TitleJournal of the American Geriatrics Society
Ethno Med: