• Bo-Hyun Cho, Cindy Weinbaum, Yuping Tsai, and Ram Koppaka.
• National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (B.C., C.W., Y.T., R.K.).
• Ann. Intern. Med. 2022 Jan 1; 175 (1): 1101-10.

BackgroundSeasonal influenza causes substantial morbidity and mortality among older U.S. adults and those with comorbid health conditions.ObjectiveTo describe seasonal influenza vaccine uptake and identify factors associated with missed opportunities for influenza vaccination.DesignRetrospective cohort study.SettingMedicare fee-for-service claims.Participants31.6 million U.S. adults continuously enrolled under Medicare Parts A and B during the 2018 to 2019 influenza season.MeasurementsInfluenza vaccine uptake and missed opportunities by patient demographic characteristics, high-risk status (that is, ≥1 condition increasing influenza complication risk), Medicare-Medicaid dual-eligibility status, and health care provider visits (that is, vaccination opportunities).ResultsOverall, 50.5% of beneficiaries aged 19 years or older had Medicare claims for influenza vaccination: 31.6% among people aged 19 to 64 years and 54% among people aged 65 years or older. More White beneficiaries were vaccinated (52.9%) than Black (34.9%) or Hispanic (30.4%) beneficiaries. Uptake was higher (56.1%) for beneficiaries with high-risk conditions than for those without (27.6%). Among unvaccinated beneficiaries overall, 77.4% visited a provider during influenza season; among unvaccinated beneficiaries with and without high-risk conditions, 91% and 43%, respectively, had seen a provider at least once. The proportion of beneficiaries with missed opportunities for influenza vaccination was 44.2% and was higher for beneficiaries in the non-high-risk group (59.1%) than those in the high-risk group (42.2%). Uptake was lower and proportions of missed opportunities were higher among beneficiaries in younger age groups, of Black and Hispanic race/ethnicity, without high-risk conditions, or with Medicare-Medicaid dual eligibility.LimitationsInfluenza vaccinations without claims could not be captured. Data on reasons for nonvaccination were unavailable.ConclusionInfluenza vaccination coverage for Medicare beneficiaries continues to be suboptimal, with missed opportunities despite availability of influenza vaccination with no copayment. Disparities persist in vaccination uptake by race/ethnicity.Primary Funding SourceNone.

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