Journal Article

Uptake and Equity in Influenza Vaccination Among Veterans with VA Coverage, Veterans Without VA Coverage, and Non-Veterans in the USA, 2019–2020

Dickman, Samuel, Woolhandler, Stephanie, Himmelstein, David U., McCormick, Danny, Gaffney, Adam

2023

Overview

Vaccination is a primary method of reducing the burden of influenza, yet uptake is neither optimal nor equitable. Single-tier, primary care-oriented health systems may have an advantage in the efficiency and equity of vaccination. To assess the association of Veterans' Health Administration (VA) coverage with influenza vaccine uptake and disparities. Cross-sectional. Adult respondents to the 2019-2020 National Health Interview Survey. We examined influenza vaccination rates, and racial/ethnic and income-based vaccination disparities, among veterans with VA coverage, veterans without VA coverage, and adult non-veterans. We performed multivariable logistic regressions adjusted for demographics and self-reported health, with interaction terms to examine differential effects by race/ethnicity and income. Our sample included n=2,277 veterans with VA coverage, n=2,821 veterans without VA coverage, and n=46,456 non-veterans. Veterans were more often White and male; among veterans, those with VA coverage had worse health and lower incomes. Veterans with VA coverage had a higher unadjusted vaccination rate (63.0%) than veterans without VA coverage (59.1%) and non-veterans (46.5%) (p<0.05 for each comparison). In our adjusted model, non-veterans were 11.4 percentage points (95% CI -14.3, -8.5) less likely than veterans with VA coverage to be vaccinated, and veterans without VA coverage were 6.7 percentage points (95% CI -10.3, -3.0) less likely to be vaccinated than those with VA coverage. VA coverage, compared with non-veteran status, was also associated with reduced racial/ethnic and income disparities in vaccination. VA coverage is associated with higher and more equitable influenza vaccination rates. A single-tier health system that emphasizes primary care may improve the uptake and equity of vaccination for influenza, and possibly other pathogens, like SARS-CoV2.

• Publisher: Springer Nature B.V,Springer International Publishing
• Subject: Adult / COVID-19 / Cross-Sectional Studies / Demographics / Health care / Humans / Immunization / Income / Influenza / Influenza Vaccines / Influenza, Human - epidemiology / Influenza, Human - prevention & control / Internal medicine / Male / Minority & ethnic groups / Original Research / Primary care / RNA, Viral / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / United States - epidemiology / Vaccination / Vaccines