Impact of Race on Immunization Status in Long-Term Care Facilities

Abstract

Objectives: This study examined the relationship between resident race and immunization status in long-term care facilities (LTCFs). Race was captured at the resident and the facility racial composition level. Design: Thirty-six long-term care facilities varying in racial composition and size were selected for site visits. Setting: LTCFs were urban and rural, CMS certified, and non-hospital administered. Measurements: Chart abstraction was used to determine race, immunization, and refusal status for the 2010–2011 flu season (influenza 1), the 2011–2012 flu season (influenza 2), and the pneumococcal pneumonia vaccine for all residents over 65 years old. Results: Thirty-five LTCFs submitted sufficient data for inclusion, and 2570 resident records were reviewed. Overall immunization rates were 70.5% for influenza 1, 74.1% for influenza 2, and 65.6% for pneumococcal pneumonia. Random effects logistic regression indicated that as the percent of Black residents increased, the immunization rate significantly decreased (immunization 1, p < 0.018, immunization 2, p < 0.002, pneumococcal pneumonia, p = 0.0059), independent of the effect of resident race which had less of an impact on rates. Conclusions: This study found considerable LTCF variation and racial disparities in immunization rates. Compared to Blacks, Whites were vaccinated at higher rates regardless of the LTCF racial composition. Facilities with a greater proportion of Black residents had lower immunization rates than those with primarily White residents. Facility racial mix is a stronger predictor of influenza immunization than resident race. Black residents had significantly higher vaccination refusal rates than White residents for immunization 2. Further studies examining LTCF-level factors that affect racial disparities in immunizations in LTCFs are needed.