Journal of General Internal Medicine

, Volume 29, Issue 12, pp 1624–1630

Can Routine Offering of Influenza Vaccination in Office-Based Settings Reduce Racial and Ethnic Disparities in Adult Influenza Vaccination?

  • Jürgen Maurer
  • Katherine M. Harris
  • Lori Uscher-Pines
Original Research



Influenza vaccination remains below the federally targeted levels outlined in Healthy People 2020. Compared to non-Hispanic whites, racial and ethnic minorities are less likely to be vaccinated for influenza, despite being at increased risk for influenza-related complications and death. Also, vaccinated minorities are more likely to receive influenza vaccinations in office-based settings and less likely to use non-medical vaccination locations compared to non-Hispanic white vaccine users.


To assess the number of “missed opportunities” for influenza vaccination in office-based settings by race and ethnicity and the magnitude of potential vaccine uptake and reductions in racial and ethnic disparities in influenza vaccination if these “missed opportunities” were eliminated.


National cross-sectional Internet survey administered between March 4 and March 14, 2010 in the United States.


Non-Hispanic black, Hispanic and non-Hispanic white adults living in the United States (N = 3,418).


We collected data on influenza vaccination, frequency and timing of healthcare visits, and self-reported compliance with a potential provider recommendation for vaccination during the 2009–2010 influenza season. “Missed opportunities” for seasonal influenza vaccination in office-based settings were defined as the number of unvaccinated respondents who reported at least one healthcare visit in the Fall and Winter of 2009–2010 and indicated their willingness to get vaccinated if a healthcare provider strongly recommended it. “Potential vaccine uptake” was defined as the sum of actual vaccine uptake and “missed opportunities.”


The frequency of “missed opportunities” for influenza vaccination in office-based settings was significantly higher among racial and ethnic minorities than non-Hispanic whites. Eliminating these “missed opportunities” could have cut racial and ethnic disparities in influenza vaccination by roughly one half.


Improved office-based practices regarding influenza vaccination could significantly impact Healthy People 2020 goals by increasing influenza vaccine uptake and reducing corresponding racial and ethnic disparities.


influenza vaccination racial and ethnic disparities healthcare provider behavior 

Supplementary material

11606_2014_2965_MOESM1_ESM.doc (97 kb)
ESM 1(DOC 97 kb)


  1. 1.
    Fiore T, Uyeki T, Broder K, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices. 2010. MMWR Recomm Rep. 2010;59(RR-8):1–62.PubMedGoogle Scholar
  2. 2.
    Thompson MG, Shay DK, Zhou H, et al. Estimates of deaths associated with seasonal influenza—United States, 1976–2007. MMWR. 2010;59(33):1057–62.Google Scholar
  3. 3.
    Hutchins SS, Fiscella K, Levine R, et al. Protection of racial/ethnic minority populations during an influenza pandemic. Am J Public Health. 2009;99(suppl 2):S261–70.PubMedCrossRefGoogle Scholar
  4. 4.
    U.S. Centers for Disease Control and Prevention. Self-reported influenza vaccination coverage trends 1989–2008 among adults by age group, risk group, race/ethnicity, health-care worker status, and pregnancy status, United States, National Health Interview Survey (NHIS). Available online at: (accessed 4 July 2014).
  5. 5.
    U.S. Centers for Disease Control and Prevention. March Flu Vaccination Coverage United States, 2011–12 Influenza Season. Available online at: (accessed 4 July 2014).
  6. 6.
    Lindley MC, Wortley PM, Winston CA, Bardenheier BH. The role of attitudes in understanding disparities in adult influenza vaccination. Am J Prev Med. 2006;31(4):281–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Hesse BW, Nelson DE, Kreps GL, et al. Trust and sources of health information. The impact of the internet and its implications for health care providers: findings from the first health information national trends survey. Arch Intern Med. 2005;165(22):2618–24.PubMedCrossRefGoogle Scholar
  8. 8.
    Maurer J, Harris KM. Contact and communication with healthcare providers regarding influenza vaccination during the 2009–2010 H1N1 pandemic. Prev Med. 2011;52(6):459–64.PubMedCrossRefGoogle Scholar
  9. 9.
    Maurer J. Who has a clue to preventing the flu? Unravelling supply and demand effects on the take-up of influenza vaccinations. J Health Econ. 2009;40(3):704–17.CrossRefGoogle Scholar
  10. 10.
    Schmitz H, Wübker A. What determines influenza vaccination take-up of elderly Europeans? Health Econ. 2011;20(11):1281–97.PubMedCrossRefGoogle Scholar
  11. 11.
    Chi RC, Neuzil KM. The association of sociodemographic factors and patient attitudes on influenza vaccination rates in older persons. Am J Med Sci. 2004;327(3):113–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Schwartz KL, Neale AV, Northrup J, et al. Racial similarities in response to standardized offer of influenza vaccination: a metronet study. J Gen Intern Med. 2006;21(4):346–51.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    U.S. Centers for Disease Control and Prevention. Place of Influenza Vaccination Among Adults --- United States, 2010–11 Influenza Season. MMWR 2011;60(23):781–785.Google Scholar
  14. 14.
    Uscher-Pines L, Maurer J, Harris KM. Racial and ethnic disparities in uptake and location of vaccination for 2009-H1N1 and seasonal influenza. Am J Public Health. 2011;101(7):1252–5.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Hebert PL, Frick KD, Kane RL, et al. The causes of racial and ethnic differences in influenza vaccination rates among elderly Medicare beneficiaries. Health Serv Res. 2005;40:517–37.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    U.S. Centers for Disease Control and Prevention. Increasing adult vaccination rates: What works: Strategies list. Available online at: (accessed 4 July 2014)
  17. 17.
    Maurer J, Harris KM, Lurie N. Reducing missed opportunities to vaccinate adults against influenza: what is realistic? Arch Intern Med. 2009;169(17):1633–4.PubMedCrossRefGoogle Scholar
  18. 18.
    GfK. KnowledgePanel Available online at: (accessed 4 July 2014).
  19. 19.
    Knowledge Networks. Overview of KnowledgePanel statistical weighting protocol. 11 Nov 2009. Available at: (accessed 4 July 2014).
  20. 20.
    U.S. Centers for Disease Control and Prevention. CDC health disparities and inequalities report—United States, 2011. MMWR. 2011;60(Suppl):1–113.Google Scholar
  21. 21.
    Harris KM, Maurer J, Kellermann A. Flu vaccine: safe, effective, and mistrusted. N Engl J Med. 2010;363(23):2183–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Groom HC, Zhang F, Fisher AK, Wortley PM. Differences in adult influenza vaccine-seeking behavior: the roles of race and attitudes. J Public Health Manag Pract. 2014;20(2):246–50.PubMedCrossRefGoogle Scholar
  23. 23.
    Yoo BK, Kasajima M, Phelps CE, Fiscella K, Bennett NM, Szilagyi PG. Influenza vaccine supply and racial/ethnic disparities in vaccination among the elderly. Am J Prev Med. 2011;40(1):1–10.PubMedCrossRefGoogle Scholar
  24. 24.
    Yoo BK. How to improve influenza vaccination rates in the U.S. J Prev Med. Public Health. 2011;44(4):141–8.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Walker AT, Smith PJ, Kolasa M. Reduction of racial/ethnic disaprities in vaccination coverage, 1995–2011. MMWR. 2014;63(1):7–12.PubMedGoogle Scholar
  26. 26.
    Knowledge Networks. GfK bibliography: Articles and presentations based on GfK’s collected panel data, analysis or methodology. Available at: (accessed 4 July 2014)
  27. 27.
    U.S. Department of Health and Human Services. Healthy People 2020. 2020 Topics & Objectives. Immunization and Infectious Diseases. Available online at: (accessed 4 July 2014).
  28. 28.
    Maurer J, Harris KM. Issuance of patient reminders for influenza vaccination by US-based primary care physicians during the first year of universal influenza vaccination recommendations. Am J Public Health. 2014;104(6):e60–2.PubMedCrossRefGoogle Scholar
  29. 29.
    U.S. Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR. 2010;59(No. RR-8):1–62.Google Scholar
  30. 30.
    Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff. 2011;30(3):464–71.CrossRefGoogle Scholar
  31. 31.
    Oster A, Bindman AB. Emergency department visits for ambulatory care sensitive conditions: insights into preventable hospitalizations. Med Care. 2003;41(2):198–207.PubMedGoogle Scholar
  32. 32.
    Bach PB, Pham HH, Schrag D, et al. Primary care physicians who treat blacks and white. N Engl J Med. 2004;351(6):575–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Escarce JJ. Racial and ethnic disparities in access to and quality of health care. Robert Wood Johnson Foundation, Research Synthesis Report No. 12 2007:1–32.Google Scholar

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Jürgen Maurer
    • 1
    • 2
  • Katherine M. Harris
    • 3
    • 2
  • Lori Uscher-Pines
    • 2
  1. 1.Institute of Health Economics and ManagementUniversity of LausanneLausanneSwitzerland
  2. 2.RAND CorporationArlingtonUSA
  3. 3.MedStar Health Research InstituteHyattsvilleUSA

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