The Causes of Racial and Ethnic Differences in Influenza Vaccination Rates among Elderly Medicare Beneficiaries

The purpose of this paper is to explore three potential causes of racial/ethnic differences in influenza vaccination rates in the elderly: 1. resistant attitudes and beliefs regarding vaccination by African-American and Hispanic Medicare beneficiaries, 2. poor access to care during influenza vaccination weeks, and 3. discriminatory behavior by providers. White beneficiaries were more likely to self-report having received vaccination than were African Americans or Hispanics. Resistance to vaccination plays a role in low vaccination rates of African-American, but not Hispanic beneficiaries. Minority beneficiaries remained unvaccinated despite having medical encounters with their usual providers on days when those same providers were administering vaccinations to white beneficiaries. Disparities in access to care and provider discrimination play little role in explaining racial/ethnic disparities in influenza vaccination. Eliminating missed opportunities for vaccination in 1995 would have raised vaccination rates in three racial/ethnic groups to the Healthy People 2000 goal of 60% vaccination.