Study reveals disparities in flu vaccination rates among US dialysis facilities

Chloe Meck cmeck@bidmc.harvard.edu

AUGUST 21, 2020

Study reveals disparities in flu vaccination rates among US dialysis facilities

Boston – To maximize community protection against viral illnesses, vaccination must be widespread. Understanding vaccination barriers can help better prepare for large-scale vaccination campaigns, such as those that will be needed when a COVID-19 vaccine is available.

Previous research has shown racial and ethnic disparities in seasonal flu vaccination rates. In a study published today in the Journal of the American Society of Nephrology, John Danziger, MD, MPhil, a nephrologist at Beth Israel Deaconess Medical Center (BIDMC), and colleagues report that similar disparities exist among patients with kidney failure, who are both at higher risk for complications of infection and have regular contact with the health care system. Specifically, the researchers also found that seasonal flu vaccination rates are lower among dialysis facilities with larger proportions of minority patients, and the gap seems to be widening over time.

“The population of patients with kidney failure is important to study, because these patients are often uniformly covered by Medicare and often visit dialysis facilities, which have a central role in coordinating vaccination administration,” said Danziger. “People with kidney failure are well-situated to receive vaccination uniformly, and disparities in receipt of vaccination reflect systemic factors above and beyond insurance coverage or access to care.”

To determine whether vaccination rates at dialysis facilities differ according to racial and ethnic composition, the team examined flu vaccination data submitted by 6,735 U.S. facilities between 2014 and 2017. They found that the average percentage of patients vaccinated during the influenza season was 72.1 percent. Facilities with higher proportions of Black and Hispanic patients had significantly lower vaccination percentages than less diverse facilities.

In addition, the average proportion of patients vaccinated at each facility decreased by 1.05 percent between 2014 and 2017, and rates declined to a greater extent among facilities with higher proportions of minorities. In facilities with the highest proportions of Black patients, the share of vaccinated patients decreased 1.21 percent per year, compared with a decrease of only 0.88 percent per year in facilities with the lowest proportions of Black patients. The investigators found similar trends for Hispanic patients.

“The failure to uniformly vaccinate patients seen in facilities with larger minority populations has important implications for those individuals and their communities and is a missed opportunity to protect the most vulnerable,” said Danziger. “The COVID-19 pandemic will almost certainly require a large-scale vaccination campaign. Our study underscores which populations are at greatest need for vaccination outreach programs, particularly because minorities are at increased risk of COVID-19 complications.”

Study co-authors include Eric Weinhandl, PhD, MS, David Friedman, MD, and Kenneth J. Mukamal, MD, MPH, also of BIDMC.

The authors have no conflicts of interest to disclose.

About Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School and consistently ranks as a national leader among independent hospitals in National Institutes of Health funding. BIDMC is the official hospital of the Boston Red Sox.

Beth Israel Deaconess Medical Center is a part of Beth Israel Lahey Health, a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,800 physicians and 36,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.