Rural-urban differences in the location of influenza vaccine administration.

BACKGROUND: Influenza vaccination rates remain lower than Healthy People 2010 goals. The lower rates are prevalent in rural areas despite an expansion of services to nontraditional settings. Little is known about disparities in influenza vaccination rates and location of receipt among rural residents. This study seeks to determine if rural residents differ from urban residents in where they obtain an influenza vaccination, and to determine what factors contribute to these differences.
METHODS: Data from 2002-2005 BRFSS were used and combined with the 2006 Area Resource File (analytic n=70,468, unweighted, 48,392,455 weighted). Unadjusted analyses examined the proportions of influenza vaccinations obtained in traditional clinical settings vs. others across rurality: Urban, Large Rural and Small Rural. Multivariable logistic regression models were conducted to identify individual and county-level factors associated with the higher rate of vaccinations in clinical settings.
RESULTS: Rural residents, particularly in Small Rural counties (80.8%) were more dependent upon clinical settings than Urban residents (69.1%) for influenza vaccinations. In adjusted analyzes, living in a Large or Small Rural county remained significant related to an increased odds of being vaccinated in a clinical setting (OR 1.17, 95% CI 1.06-1.29 and OR 1.45, 95% CI 1.24-1.69 respectively). Other related contributory factors included socioeconomic factors, health status, health condition, and per capita income of the county.
CONCLUSIONS: Rural residents depend upon traditional, clinical settings when an influenza vaccination is sought. The results can be used for further research and programs to improve access to and delivery of influenza vaccinations for disparate populations.