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Study Finds Persistent Racial/Ethnic, Socioeconomic Disparities in Adult Vaccination Coverage 2010 - 2019


Rates of routine ACIP-recommended vaccination have been persistently and significantly lower among racial and ethnic minorities over the past decade, according to new research.

A new study on US vaccine trends finds that although overall adult vaccination rates steadily increased from 2010 to 2019, racial and ethnic disparities in uptake remained persistent during that time for critical influenza, pneumococcal, shingles, and Tdap vaccinations.

While The COVID-19 pandemic has for more than a year eclipsed focus on unequal uptake of vaccination against common vaccine-preventable diseases, the trend in vaccination against SARS-CoV-2 infection among racial and ethnic minorities has mirrored the study’s findings, according to authors.

“Currently, the biggest public health concern we are facing is the COVID-19 pandemic, for which we now have safe and effective vaccines available in the USA,” explained investigators Kosuke Kawai, ScD, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital and Harvard Medical School and Alison Tse Kawai, ScD, RTI Health Solutions, Waltham, MA, in a press release. “Unfortunately, as we observed for vaccines against influenza, pneumococcal, shingles, and Tdap…adults from racial and ethnic minorities have had lower rates of COVID-19 vaccine uptake.”

Writing in the American Journal of Preventive Medicine, study authors cite the annual threat posed by influenza which is responsible for between 140 000 to 710 000 hospitalizations each year and disproportionately affects racial and ethnic minority groups and adults living in vulnerable, low-income communities. Other vaccine-preventable diseases also are often more prevalent in these populations, they assert.

Noting the lack of research on trends in vaccine coverage rates in recent years, Kawai et al sought to evaluate temporal trends in adult vaccination uptake by race/ethnicity and socioeconomic status from 2010 to 2019 for routine inoculation recommended by the Advisory Committee on Immunization Practices against influenza, pneumococcal disease, herpes zoster, and tetanus, diphtheria, and acellular pertussis (Tdap).

Study data were drawn from the National Health Interview Survey (NHIS) from 2010 to 2019 and investigators reviewed self-reported receipt of:

  • Influenza vaccine in the past 12 months
  • Tdap vaccine in the past 10 years
  • Ever receipt of a pneumococcal vaccine
  • Ever receipt of a zoster vaccine

Adults aged 18−64 years were queried about receipt of influenza and Tdap vaccinations. Among those aged ≥65 years, receipt of influenza, Tdap, pneumococcal, and zoster vaccinations were recorded.


Data from a total of 311 343 adults from the NHIS 2010-2019 were included.

Socioeconomic differences in influenza vaccine uptake narrowed among adults aged 18–64 years from 2010 to 2019, possibly a result, the authors suggest, related to enactment of the Affordable Care Act in 2014. However, racial/ethnic and socioeconomic differences in vaccine uptake persisted from 2010 to 2019 among more vulnerable adults aged ≥65 years: Black 61.4%; Hispanic 63.9%; Asian 71.9%; White 72.4%.

Among adults aged 18−64 years but not among those aged ≥65 years, the annual increase in influenza vaccine coverage differed by household income.

Investigators reported persistent racial/ethnic differences in pneumococcal and zoster vaccine coverage from 2010 to 2019. The magnitude of the annual increase in zoster vaccine was greater among White than Black and Hispanic individuals:

White: annual increase of 3.3% ([95% CI=3.1, 3.5)

Black: 2.5% (95% CI=2.2, 2.8)

Hispanic: 2.4% (95% CI=2.0,2.8)

Pinteraction <.001 between year and race/ethnic groups

Race/ethnicity, household income, education level, and health insurance type were significantly associated with receipt of influenza, pneumococcal, Tdap, and zoster vaccinations among adults aged ≥65 years after researcher adjusted for access to health care and sociodemographic factors in the multivariable regression model.

“Although the COVID-19 pandemic is the primary public health concern at the moment, our findings also serve as a reminder of the importance of continuing to strive towards equity in immunization rates for vaccines against other vaccine-preventable diseases,” the investigators commented. In addition to building trust and vaccine confidence through community engagement, reducing cost barriers especially for adults 65 years or older and implementing provider/patient reminder and recall systems using an Immunization Information System, could narrow the disparities in immunization rates.”

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