• Barbara Bardenheier, Pascale Wortley, Faruque Ahmed, Stefan Gravenstein, and Hogue Carol J Rowland CJ.
• Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. bfb7@cdc.gov
• Med Care. 2011 Apr 1; 49 (4): 371-7.

BackgroundAlthough influenza vaccination is recommended for all nursing home residents and is covered by Medicare, racial inequities remain.ObjectivesTo determine the extent of racial difference in influenza vaccination among nursing home residents within and between nursing facilities by facility resident racial composition in a state with a large White-Black difference in vaccination.Research DesignData from the Centers for Medicaid & Medicare Services' (CMS) Minimum Data Set (MDS) for assessments from October 1, 2005 through March 31, 2006. Facility-level data for nonhospital-administered CMS-certified nursing facilities in Michigan were merged with MDS.SubjectsAll nursing home residents (n=90,120).Main Outcome MeasureReceipt, refusal, or unvaccinated due to contraindication or not being offered the influenza vaccine.ResultsThe unadjusted influenza vaccination coverage of residents was 60.6%, 63.5% for whites, and 43.0% for blacks, a difference of 20.5 percentage points. The adjusted median range of inequity (white-black) within homes stratified by proportion blacks in the facility (eg, 0%, 1% to 4.9%, 5% to 19.9%, 20% to 49.9%, and ≥50%) was 5.0% to 5.6% points. White residents refused the vaccine less than black residents in all groups of homes by proportion blacks in the home, ranging from 7.6% [corrected] in the all white homes to 14.3% [corrected] among blacks in homes with >50% black residents. The adjusted median black deficit in not being offered the vaccine between nursing homes was large (up to 26.0% [corrected] points between all white homes and homes with >50% blacks).ConclusionMichigan statewide vaccination inequity among nursing home residents results from blacks disproportionately living in nursing homes where vaccination coverage is lowest. The inequity between facilities can be attributed to facility-level difference in offering.

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