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

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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.

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Acknowledgments

The authors wish to acknowledge and thank Drs. Keith Sigel and Ana Blohm for their preliminary work in this subject area, and the clinical and non-clinical staff of the Mount Sinai Visiting Doctors Program who collected the clinical data for this analysis. Dr. Banach was supported by an award UL1RR029887 from the National Center for Research Resources. There are no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Medicine, Mount Sinai School of Medicine, 1 Gustave Levy Place, Box 1090, New York, NY, 10029, USA

    David B. Banach, Katherine Ornstein, Stephanie H. Factor & Theresa A. Soriano

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA

    Katherine Ornstein

Authors
  1. David B. Banach
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  2. Katherine Ornstein
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  3. Stephanie H. Factor
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  4. Theresa A. Soriano
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Correspondence to David B. Banach.

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Banach, D.B., Ornstein, K., Factor, S.H. et al. Seasonal Influenza Vaccination among Homebound Elderly Receiving Home-Based Primary Care in New York City. J Community Health 37, 10–14 (2012). https://doi.org/10.1007/s10900-011-9409-z

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  • DOI: https://doi.org/10.1007/s10900-011-9409-z

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