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

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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References

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    Article  Google Scholar 

  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. 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. 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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

  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. 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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Article  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    PubMed  Article  CAS  Google Scholar 

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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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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

Keywords

  • Influenza vaccination
  • Homebound elderly