The Time Is Now: Get Your Flu Shot!

A new study done at Brown University has found that the proportion of nursing home patients who get a shot remains lower than a national public health goal and that the rate is lower for blacks than for whites. It serves as a reminder of just how important getting your flu shot is, and now is the time to get it.

The elderly are especially vulnerable to the flu, with people older than 65 accounting for the majority of flu-related deaths every year in the United States.

In the Brown study, a team led by community health investigator Shubing Cai looked at hundreds of thousands of patient records from more than 14,000 nursing homes each year between the 2006-07 and 2008-09 flu seasons.

The researchers found that the overall vaccination rate in the latest year is 82.75 percent, which is short of the 90 percent goal set by Medicare and Medicaid. For whites the rate was 83.46 percent, while for blacks it was 77.75 percent. One positive is that these rates are slightly higher than in 2006-2007, but the disparity between the races persists even within individual nursing homes.

"One reason you would potentially see a difference is that blacks and whites are by and large served by different nursing homes and there's lots of evidence to suggest that blacks are served in nursing homes that are not as good," said Vincent Mor, professor of health services policy and practice at Brown and senior author of the study published in the October issue of Health Affairs. "However, we also see a pretty persistent difference within the same homes, although it is not as large and it has lessened over time."

When the team analyzed the relative risk of going unvaccinated, they found that while the disparity is dropping overall, it remains significant even within the same homes where service quality and staffing levels are presumably the same for blacks and whites. In 2008-09 blacks overall were about 23 percent less likely than whites to be vaccinated and about 15 percent less likely to be vaccinated as their white neighbors within the same home.

Much, though not all, of the reason why blacks receive fewer vaccinations is because they turn them down more often, Cai said. According to the records, black patients refused vaccinations in 12.88 percent of cases in 2008-09, accounting for more than half of the situations where no vaccination occurred. Whites only turned down vaccines at a rate of 8.93 percent.

The higher rate of refusal among blacks declined over time, but didn't fully explain the disparity within a facility, Cai said. "After we dropped patients who declined offers from the analysis, we still saw a difference within facilities," she said. And blacks were also less likely to be offered vaccines.

Finding the single best way to resolve the disparity may well require interventions to determine what mix of factors are afoot in individual homes, Mor said. One question worth further study, he said, is whether the higher rate of vaccine refusal among black patients perhaps reflects how the vaccines are being offered.

The Bottom Line On Flu Vaccines

Everyone 6 months of age and older should get a flu vaccine each flu season, and getting one is especially important for certain people at high risk of having serious flu-related complications or who live with or care for people at high risk for developing flu-related complications:

• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
  • People who live with or care for those at high risk for complications from flu, including:
  • Health care workers
  • Household contacts of persons at high risk for complications from the flu
  • Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

A Flu Vaccine Every Flu Season

People should get vaccinated every year for two reasons, say the experts at the Centers for Disease Control and Prevention (CDC). First, because flu viruses are constantly changing, flu vaccines may be updated from one season to the next to protect against the most recent and most commonly circulating viruses. Second, your immune protection from vaccination declines over time, so annual vaccination is needed to give you the best protection.

Easier Than You Think

Think that getting your flu vaccine is an inconvenience, too time-consuming or expensive? Think again—flu vaccine shipments began in August and ample supplies are available in many convenient locations. A nurse at your doctor’s office may be able to give it to you without a regular visit and it’s also offered at many places you normal go to, like your pharmacy or grocery store. Use the CDC’s flu clinic locator to find the vaccine in your area; all you need to do is enter your zip code. Protect yourself and your loved ones. Get your vaccine now, and be protected until next fall.