A Multi-Level Examination of Influenza Vaccination Disparities from the 2009 Behavioral Risk Factor Surveillance System

Vaccinations were noted as the top public health achievement in the 20th century (Centers for Disease Control and Prevention 1999). However, not everyone is getting vaccinated. Taking a sociological approach this study examined the extent to which African Americans, American Indian/Alaska Natives, and Latino populations received an influenza vaccination compared to whites at a micro and macro level from the 2009 Behavioral Risk Factor Surveillance System. Previous research on racial and ethnic health disparities, attitudinal difference, and other demographic characteristics are reviewed in the literature. The Behavioral Model of Health Services was employed as the theoretical framework for this study. The methods consisted of three levels of analysis beginning with multivariate logistic regression at the individual level, least squares dummy variable modeling (LSDV), and hierarchical logistic regression modeling to incorporate aggregate data from the 50 United States. The results from the logistic regression show African Americans and Latino respondents have lesser odds of receiving the flu vaccine compared to whites after controlling for medical costs, access to health care, and a variety of socio-demographic characteristics. Results also show American Indian/Alaska Natives had greater odds of receiving the flu vaccine compared to whites after introducing similar control variables. Least Squares Dummy Variable Modeling controlled for the effects states have on receiving a flu vaccine. The results presented were African Americans and Latinos have significant lesser odds of receiving the flu vaccine compared to whites. While American Indian/Alaska Natives had greater odds of receiving a flu vaccine compared to whites, statistical significance was lost once states were used as control variables. It was also found 13 states had greater odds and 13 states had lesser odds of receiving the flu vaccine compared to North Dakota. Hierarchical logistic regression models examined the influence of state level covariates on the odds of individuals receiving the flu vaccine, and the results indicated that African Americans and Latinos had lesser odds of receiving an influenza vaccine compared to whites, but American Indian/Alaska Natives were found to have greater odds compared to whites, with the results not being statistically significant. The implications of these results are discussed