Journal of Community Health

, Volume 37, Issue 1, pp 10–14 | Cite as

Seasonal Influenza Vaccination among Homebound Elderly Receiving Home-Based Primary Care in New York City

  • David B. Banach
  • Katherine Ornstein
  • Stephanie H. Factor
  • Theresa A. Soriano
Original Paper

Abstract

Seasonal influenza vaccination is recommended for all persons aged ≥50 years to reduce influenza related morbidity and mortality, but vaccination coverage among community-dwelling elderly remains low. Homebound elderly receiving home-based primary care (HBPC) have fewer barriers to vaccination than other community-dwelling elderly. The Mount Sinai Visiting Doctors (MSVD) program provides HBPC to homebound elderly in New York City. This study assessed seasonal influenza vaccination coverage within an urban HBPC program and identified factors associated with vaccine refusal. A cross-sectional analysis of data from the 2008–2009 influenza season was completed and influenza vaccination coverage was assessed. The association between social, demographic and health-related characteristics and vaccine refusal was evaluated using bivariate analysis and multivariable logistic regression. Of 689 people aged >65 eligible for influenza vaccination, 578 (84%) accepted and 111 (16%) refused vaccination. In multivariable analysis, vaccine refusal was positively associated with female gender (adjusted odds ratio [AOR] = 1.85, 95% confidence interval [CI] 1.02, 3.35), black race (AOR = 2.04, 95% CI 1.28, 3.25), and living alone (AOR = 1.71, 95% CI 1.10, 2.67), and negatively associated with dementia (AOR = 0.59, 95% CI 0.37, 0.91). Seasonal influenza vaccine coverage in the MSVD program was high compared to nursing home and community-dwelling elderly. Offering patients vaccination at home without additional expense will likely improve vaccine coverage among urban homebound elderly. Understanding why vaccine refusal rates are higher among females, black patients, and those living alone should guide interventions to increase vaccine acceptance among this population.

Keywords

Influenza vaccination Homebound elderly 

References

  1. 1.
    Thompson, W. W., Shay, D. K., Weintraub, E., et al. (2004). Influenza-associated hospitalizations in the United States. Journal of the American Medical Association, 292(11), 1333–1340.PubMedCrossRefGoogle Scholar
  2. 2.
    Thompson, W. W., Shay, D. K., Weintraub, E., et al. (2003). Mortality associated with influenza and respiratory syncytial virus in the United States. Journal of the American Medical Association, 289(2), 179–186.PubMedCrossRefGoogle Scholar
  3. 3.
    Nichol, K. L., Nordin, J. D., Nelson, D. B., Mullooly, J. P., & Hak, E. (2007). Effectiveness of influenza vaccine in the community-dwelling elderly. New England Journal of Medicine, 357(14), 1373–1381.PubMedCrossRefGoogle Scholar
  4. 4.
    Talbot, H. K., Griffin, M. R., Chen, Q., Zhu, Y., Williams, J. V., & Edwards, K. M. (2011). Effectiveness of seasonal vaccine in preventing confirmed influenza-associated hospitalizations in community-dwelling older adults. Journal of Infectious Diseases, 203(4), 1–9.CrossRefGoogle Scholar
  5. 5.
    Centers for Disease Control, Prevention. (2009). Influenza vaccination coverage among children and adults—United States, 2008–2009 influenza season. Morbidity and Mortality Weekly Report, 58(39), 1091–1095.Google Scholar
  6. 6.
    Department of Health and Human Services. (2000). Department of health and human services, healthy people, 2010. Retrieved April 1, 2011. Available from: URL:http://www.healthypeople.gov/2010/.
  7. 7.
    Desai, N. R., Smith, K. L., & Boal, J. (2008). The positive financial contribution of home-based primary care programs: The case of the Mount Sinai visiting doctors. Journal of the American Geriatrics Society, 56(4), 744–749.PubMedCrossRefGoogle Scholar
  8. 8.
    Brickner, P. W., Teresita Duque, S., et al. (1975). The homebound aged: A medically unreached group. Annals of Internal Medicine, 82(1), 1–6.PubMedGoogle Scholar
  9. 9.
    Vlahov, D., Coady, M. H., Ompad, D. C., & Galea, S. (2007). Strategies for improving influenza immunization rates among hard-to-reach populations. Journal of Urban Health, 84(4), 615–631.PubMedCrossRefGoogle Scholar
  10. 10.
    Smith, K. L., Ornstein, K., Soriano, T., Muller, D., & Boal, J. (2006). A multidisciplinary program for delivering primary care to the underserved urban homebound: Looking back, moving forward. Journal of the American Geriatrics Society, 54(8), 1283–1289.PubMedCrossRefGoogle Scholar
  11. 11.
    Ganguly, R., & Cameron, D. (1989). Factors affecting immunization rate in a cohort of elderly veterans: A retrospective pilot study of influenza vaccine compliance. Vaccine, 7(5), 462–464.PubMedCrossRefGoogle Scholar
  12. 12.
    Bryant, W. K., Ompad, D. C., Sisco, S., et al. (2006). Project VIVA intervention working group. Determinants of influenza vaccination in hard-to-reach urban populations. Preventive Medicine, 43(1), 60–70.PubMedCrossRefGoogle Scholar
  13. 13.
    Li, Y., & Mukamel, D. B. (2009). Racial disparities in receipt of influenza and pneumococcus vaccinations among US nursing home residents. American Journal of Public Health, 100(Suppl 1), S256–S262.Google Scholar
  14. 14.
    Marin, M. G., Johanson, W. G., Jr, & Salas-Lopez, D. (2002). Influenza vaccination among minority populations in the United States. Preventive Medicine, 34(2), 235–241.PubMedCrossRefGoogle Scholar
  15. 15.
    Straits-Troster, K. A., Kahwati, L. C., Kinsinger, L. S., Orelien, J., Burdick, M. B., & Yevich, S. J. (2006). Racial/ethnic differences in influenza vaccination in the veterans affairs healthcare system. American Journal of Preventive Medicine, 31(5), 375–382.PubMedCrossRefGoogle Scholar
  16. 16.
    Rangel, M. C., Shoenbach, V. J., Weigle, K. A., Hogan, V. K., Strauss, R. P., & Bangdiwala, S. I. (2005). Racial and ethnic disparities in influenza vaccination among elderly adults. Journal of General Internal Medicine, 20(5), 426–431.PubMedCrossRefGoogle Scholar
  17. 17.
    Egede, L. E., & Zheng, D. (2003). Racial/ethnic differences in influenza vaccination coverage in high-risk adults. American Journal of Public Health, 93(12), 2074–2078.PubMedCrossRefGoogle Scholar
  18. 18.
    Hebert, P. L., Frick, K. D., Kane, R. L., & McBean, A. M. (2005). The causes of racial and ethnic differences in influenza vaccination rates among elderly medicare beneficiaries. Health Service Research, 40(2), 517–537.CrossRefGoogle Scholar
  19. 19.
    Singleton, J. A., Santibanez, T. A., & Wortley, P. M. (2005). Influenza and pneumococcal vaccination of adults aged >or = 65: Racial/ethnic differences. American Journal of Preventive Medicine, 29(5), 412–420.PubMedCrossRefGoogle Scholar
  20. 20.
    Wray, R. J., Buskirk, T. D., Jupka, K., et al. (2009). Influenza vaccination concerns among older blacks: A randomized controlled trial. American Journal of Preventive Medicine, 36(5), 429–434.PubMedCrossRefGoogle Scholar
  21. 21.
    Cleary, P. D., Zaslavsky, A. M., & Cioffi, M. (2000). Sex differences in assessments of the quality of medicare managed care. Women’s Health Issues, 10(20), 70–79.PubMedGoogle Scholar
  22. 22.
    Breeze, E., Mangtani, P., Fletcher, A. E., Price, G. M., Kovats, S., & Roberts, J. (2004). Trends in influenza vaccination uptake among people aged over 74 years, 1997–2000: Survey of 73 general practices in Britain. BMC Family Practice, 5, 8.PubMedCrossRefGoogle Scholar
  23. 23.
    Nowalk, M. P., Zimmerman, R. K., Shen, S., Jewell, I. K., & Raymund, M. (2004). Barriers to pneumococcal and influenza vaccination in older community-dwelling adults (2000–2001). Journal of the American Geriatric Society, 52(1), 25–30.CrossRefGoogle Scholar
  24. 24.
    Houston, M. S., Silverstein, M. D., & Suman, V. J. (1997). Risk factors for 30-day mortality in elderly patients with lower respiratory tract infection. Community-based study. Archives of Internal Medicine, 157(19), 2190–2195.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • David B. Banach
    • 1
  • Katherine Ornstein
    • 1
    • 2
  • Stephanie H. Factor
    • 1
  • Theresa A. Soriano
    • 1
  1. 1.Department of MedicineMount Sinai School of MedicineNew YorkUSA
  2. 2.Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew YorkUSA

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