Joint Commission, Oakbrook Terrace, IL, USA.
J Racial Ethn Health Disparities. 2019 Feb;6(1):153-159. doi: 10.1007/s40615-018-0510-1. Epub 2018 Jul 12.
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.
Thirty-six long-term care facilities varying in racial composition and size were selected for site visits.
LTCFs were urban and rural, CMS certified, and non-hospital administered.
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.
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.
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.
本研究考察了长期护理机构（LTCF）中居民种族与免疫状况之间的关系。种族是在居民和设施种族构成两个层面上进行采集的。
选择了 36 家种族构成和规模各异的长期护理机构进行现场访问。
LTCF 为城市和农村地区，经 CMS 认证，非医院管理。
通过图表摘要确定了 2010-2011 流感季节（流感 1）、2011-2012 流感季节（流感 2）以及所有 65 岁以上居民的肺炎球菌疫苗的种族、免疫和拒绝接种情况。
35 家 LTCF 提交了足够的数据纳入研究，共回顾了 2570 名居民的记录。流感 1 的总体免疫率为 70.5%，流感 2 的免疫率为 74.1%，肺炎球菌疫苗的免疫率为 65.6%。随机效应逻辑回归表明，随着黑人居民比例的增加，免疫率显著下降（免疫接种 1，p<0.018；免疫接种 2，p<0.002；肺炎球菌疫苗，p=0.0059），独立于居民种族的影响，而居民种族对比率的影响较小。
本研究发现长期护理机构的免疫接种率存在相当大的差异和种族差异。与黑人相比，无论长期护理机构的种族构成如何，白人的接种率都更高。黑人居民比例较高的机构的免疫接种率低于以白人居民为主的机构。设施的种族构成是流感免疫接种的一个更强的预测指标，而不是居民种族。黑人居民对免疫接种 2 的接种拒绝率明显高于白人居民。需要进一步研究影响长期护理机构中种族差异的长期护理机构层面的因素。
