• Adam Gaffney, David U Himmelstein, Samuel Dickman, Danny McCormick, and Stephanie Woolhandler.
• Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA. agaffney@cha.harvard.edu.
• J Gen Intern Med. 2023 Apr 1; 38 (5): 115211591152-1159.

BackgroundVaccination 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.ObjectiveTo assess the association of Veterans' Health Administration (VA) coverage with influenza vaccine uptake and disparities.DesignCross-sectional.ParticipantsAdult respondents to the 2019-2020 National Health Interview Survey.Main MeasuresWe 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.Key ResultsOur 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.ConclusionsVA 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.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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