William K Bleser1, Patricia Y Miranda, Muriel Jean-Jacques. 1. *Department of Health Policy and Administration, Pennsylvania State University, University Park, PA †Department of Medicine, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND: Despite well-established programs, influenza vaccination rates in US adults are well below federal benchmarks and exhibit well-documented, persistent racial and ethnic disparities. The causes of these disparities are multifactorial and complex, though perceived racial/ethnic discrimination in health care is 1 hypothesized mechanism. OBJECTIVES: To assess the role of perceived discrimination in health care in mediating influenza vaccination RACIAL/ETHNIC disparities in chronically ill US adults (at high risk for influenza-related complications). RESEARCH DESIGN: We utilized 2011-2012 data from the Aligning Forces for Quality Consumer Survey on health and health care (n=8127), nationally representative of chronically ill US adults. Logistic regression marginal effects examined the relationship between race/ethnicity and influenza vaccination, both unadjusted and in multivariate models adjusted for determinants of health service use. We then used binary mediation analysis to calculate and test the significance of the percentage of this relationship mediated by perceived discrimination in health care. RESULTS: Respondents reporting perceived discrimination in health care had half the uptake as those without discrimination (32% vs. 60%, P=0.009). The change in predicted probability of vaccination given perceived discrimination experiences (vs. none) was large but not significant in the fully adjusted model (-0.185; 95% CI, -0.385, 0.014). Perceived discrimination significantly mediated 16% of the unadjusted association between race/ethnicity and influenza vaccination, though this dropped to 6% and lost statistical significance in multivariate models. CONCLUSIONS: The causes of persistent racial/ethnic disparities are complex and a single explanation is unlikely to be sufficient. We suggest reevaluation in a larger cohort as well as potential directions for future research.
BACKGROUND: Despite well-established programs, influenza vaccination rates in US adults are well below federal benchmarks and exhibit well-documented, persistent racial and ethnic disparities. The causes of these disparities are multifactorial and complex, though perceived racial/ethnic discrimination in health care is 1 hypothesized mechanism. OBJECTIVES: To assess the role of perceived discrimination in health care in mediating influenza vaccination RACIAL/ETHNIC disparities in chronically ill US adults (at high risk for influenza-related complications). RESEARCH DESIGN: We utilized 2011-2012 data from the Aligning Forces for Quality Consumer Survey on health and health care (n=8127), nationally representative of chronically ill US adults. Logistic regression marginal effects examined the relationship between race/ethnicity and influenza vaccination, both unadjusted and in multivariate models adjusted for determinants of health service use. We then used binary mediation analysis to calculate and test the significance of the percentage of this relationship mediated by perceived discrimination in health care. RESULTS: Respondents reporting perceived discrimination in health care had half the uptake as those without discrimination (32% vs. 60%, P=0.009). The change in predicted probability of vaccination given perceived discrimination experiences (vs. none) was large but not significant in the fully adjusted model (-0.185; 95% CI, -0.385, 0.014). Perceived discrimination significantly mediated 16% of the unadjusted association between race/ethnicity and influenza vaccination, though this dropped to 6% and lost statistical significance in multivariate models. CONCLUSIONS: The causes of persistent racial/ethnic disparities are complex and a single explanation is unlikely to be sufficient. We suggest reevaluation in a larger cohort as well as potential directions for future research.
Authors: Arturo Vargas Bustamante; Jie Chen; Hector P Rodriguez; John A Rizzo; Alexander N Ortega Journal: Am J Prev Med Date: 2010-06 Impact factor: 5.043
Authors: Peng-Jun Lu; James A Singleton; Gary L Euler; Walter W Williams; Carolyn B Bridges Journal: Am J Epidemiol Date: 2013-09-05 Impact factor: 4.897
Authors: Jacob A Udell; Rami Zawi; Deepak L Bhatt; Maryam Keshtkar-Jahromi; Fiona Gaughran; Arintaya Phrommintikul; Andrzej Ciszewski; Hossein Vakili; Elaine B Hoffman; Michael E Farkouh; Christopher P Cannon Journal: JAMA Date: 2013-10-23 Impact factor: 56.272
Authors: Vickie L Shavers; Pebbles Fagan; Dionne Jones; William M P Klein; Josephine Boyington; Carmen Moten; Edward Rorie Journal: Am J Public Health Date: 2012-05 Impact factor: 9.308
Authors: I Looijmans-van den Akker; P M van den Heuvel; Th J M Verheij; J J M van Delden; G A van Essen; E Hak Journal: Prev Med Date: 2007-07-17 Impact factor: 4.018
Authors: Katherine M Horvath; Luisa E Brighton; Margaret Herbst; Terry L Noah; Ilona Jaspers Journal: Clin Immunol Date: 2012-01-06 Impact factor: 3.969
Authors: Sandra Crouse Quinn; Amelia Jamison; Vicki S Freimuth; Ji An; Gregory R Hancock; Donald Musa Journal: Vaccine Date: 2017-01-17 Impact factor: 3.641
Authors: Peng-Jun Lu; Mei-Chuan Hung; Alissa C O'Halloran; Helen Ding; Anup Srivastav; Walter W Williams; James A Singleton Journal: Am J Prev Med Date: 2019-08-29 Impact factor: 5.043
Authors: Don E Willis; Jennifer A Andersen; Brooke E E Montgomery; James P Selig; Sumit K Shah; Nickolas Zaller; Keneshia Bryant-Moore; Aaron J Scott; Mark Williams; Pearl A McElfish Journal: J Racial Ethn Health Disparities Date: 2022-04-07