Status of influenza and pneumococcal vaccination among older American Indians and Alaska Natives

Objectives. We sought to estimate the influenza and pneumococcal vaccination coverage among older American Indian and Alaska Native (AIAN) adults nationally and the impact of sociodemographic factors, variations by geographic region, and access to services on vaccination coverage.Methods. We obtained our sample of 1981 AIAN and 179845 White respondents 65 years and older from Behavioral Risk Factor Surveillance System data from 2003 to 2005. Logistic regression provided predictive marginal vaccination coverage for each covariate and adjusted for demographic characteristics and access to care.Results. Unadjusted influenza coverage estimates were similar between AIAN and White respondents (68.1% vs 69.5%), but pneumococcal vaccination was lower among AIAN respondents (58.1% vs 67.2%; P<.01). After multivariable adjustment for sociodemographic characteristics, self-reported coverage for both vaccines was statistically similar between AIAN and White adults.Conclusions. Although there was no disparity in influenza coverage, pneumococcal coverage was lower among AIAN than among White respondents, probably because of sociodemographic risk factors. Regional variation indicates a need to monitor coverage and target interventions to reduce disparities within geographically and culturally diverse subpopulations of AIAN persons.Racial and ethnic disparities in influenza and pneumococcal vaccinations among older adults are well documented. In the 2005 National Health Interview Survey, 63% of Whites 65 years and older in the United States reported receiving an influenza vaccine in the last 12 months, compared with 42% of Hispanics and 39% of African Americans.1 For pneumococcal vaccination, gaps of similar or greater magnitude were observed.1 These disparities have persisted over time, even as overall influenza and pneumococcal vaccination coverage has increased.2American Indians and Alaska Natives comprise approximately 1.5% of the US population,3 but they experience a significant and disproportionate burden of poor health.4 American Indian and Alaska Native (AIAN) adults are more likely than are Whites to report risk factors for chronic disease including tobacco use, obesity, diabetes, and physical inactivity, and these disparities persist among adults 55 years and older.5^,6 Rates of infant mortality and deaths associated with alcoholism, tuberculosis, and accidents are all higher among AIAN populations than among Whites, and older AIAN adults experience higher rates of invasive pneumococcal disease than does the general US population.7^,8 Urban AIAN residents, who may live farther from health facilities designated specifically for American Indians, experience similar disparities compared with general urban populations.9^,10On the basis of county- and state-level assessments using various methodologies, estimates of influenza vaccination coverage among AIAN adults 50 years and older11^,12 or 65 years and older4 range from 30% to 70%, and pneumococcal vaccination estimates range from 21% to 67%. These data suggest that in some areas, older AIAN adults receive recommended vaccines at approximately the same rate as Whites nationwide. However, there are no published estimates of vaccination coverage among a nationally based sample of AIAN adults. We sought to provide a national estimate of influenza and pneumococcal vaccination coverage among older AIAN adults (≥ 65 years) in the United States and explored the impact of sociodemographic factors, variations by geographic region, and access to services on vaccination coverage.