Impact of Race on Immunization Status in Long-Term Care Facilities

Objectives: 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.

Design: Thirty-six long-term care facilities varying in racial composition and size were selected for site visits.

Setting: LTCFs were urban and rural, CMS certified, and non-hospital administered.

Measurements: 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.

Results: 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.

Conclusions: 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.