Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
J Am Med Dir Assoc. 2021 Jun;22(6):1271-1278.e3. doi: 10.1016/j.jamda.2021.03.003. Epub 2021 Apr 7.
Quantify how observable characteristics contribute to influenza vaccination disparities among White, Black, and Hispanic nursing home (NH) residents.
Retrospective cohort.
Short- and long-stay U.S. NH residents aged ≥65 years.
We linked Minimum Data Set (MDS) and Medicare data to LTCFocUS and other facility data. We included residents with 6-month continuous enrollment in Medicare and an MDS assessment between October 1, 2013, and March 31, 2014. Residents were classified as short-stay (<100 days in NH) or long-stay (≥100 days in NH). We fit multivariable logistic regression models to assess the relationships between 27 resident and NH-level characteristics and receipt of influenza vaccination. Using nonlinear Oaxaca-Blinder decomposition, we decomposed the disparity in influenza vaccination between White versus Black and White versus Hispanic NH residents. Analyses were repeated separately for short- and long-stay residents.
Our study included 630,373 short-stay and 1,029,593 long-stay residents. Proportions vaccinated against influenza included 67.2% of White, 55.1% of Black, and 54.5% of Hispanic individuals among short-stay residents and 84.2%, 76.7%, and 80.8%, respectively among long-stay residents. Across 4 comparisons, the crude disparity in influenza vaccination ranged from 3.4 to 12.7 percentage points. By equalizing 27 prespecified characteristics, these disparities could be reduced 37.7% to 59.2%. Living in a predominantly White facility and proxies for NH quality were important contributors across all analyses. Characteristics unmeasured in our data (eg, NH staff attitudes and beliefs) may have also contributed significantly to the disparity.
The racial/ethnic disparity in influenza vaccination was most dramatic among short-stay residents. Intervening on factors associated with NH quality would likely reduce these disparities; however, future qualitative research is essential to explore potential contributors that were unmeasured in our data and to understand the degree to which these factors contribute to the overall disparity in influenza vaccination.
量化观察特征如何导致白人、黑人和西班牙裔养老院（NH）居民中流感疫苗接种的差异。
回顾性队列研究。
65 岁以上的美国 NH 短期和长期居民。
我们将最低数据集（MDS）和医疗保险数据与 LTCFocUS 和其他设施数据相关联。我们纳入了在 Medicare 中有 6 个月连续参保并在 2013 年 10 月 1 日至 2014 年 3 月 31 日期间进行 MDS 评估的居民。居民被分为短期入住（NH 入住<100 天）或长期入住（NH 入住≥100 天）。我们使用多变量逻辑回归模型评估 27 名居民和 NH 水平特征与流感疫苗接种之间的关系。使用非线性 Oaxaca-Blinder 分解，我们对白人居民与黑人居民和白人居民与西班牙裔居民之间的流感疫苗接种差异进行了分解。分析分别针对短期和长期居民重复进行。
我们的研究包括 630373 名短期居民和 1029593 名长期居民。短期居民中接种流感疫苗的比例包括 67.2%的白人、55.1%的黑人、54.5%的西班牙裔，长期居民中接种流感疫苗的比例分别为 84.2%、76.7%和 80.8%。在 4 项比较中，流感疫苗接种的粗差异范围为 3.4 至 12.7 个百分点。通过平等化 27 个预先指定的特征，可以将这些差异减少 37.7%至 59.2%。在所有分析中，居住在以白种人为主的机构和 NH 质量的代表是重要的促成因素。我们数据中未测量的特征（例如 NH 工作人员的态度和信念）也可能对差异有重大贡献。
在短期居民中，流感疫苗接种的种族/民族差异最为显著。干预与 NH 质量相关的因素可能会降低这些差异；然而，未来的定性研究对于探索我们数据中未测量的潜在因素以及了解这些因素对流感疫苗接种整体差异的贡献程度至关重要。
