Uptake and Equity in Influenza Vaccination Among Veterans with VA Coverage,Veterans Without VA Coverage,and Non-Veterans in the USA, 2019–2020 |
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| Authors: | Adam Gaffney David U. Himmelstein Samuel Dickman Danny McCormick Stephanie Woolhandler |
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| Affiliation: | 1.Department of Medicine, Cambridge Health Alliance, Cambridge, MA USA ;2.Harvard Medical School, Boston, MA USA ;3.Hunter College, City University of New York, New York, NY USA ;4.Public Citizen Health Research Group, Washington, DC USA ;5.Planned Parenthood South Texas, San Antonio, TX USA |
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| Abstract: | 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.KEY WORDS: influenza, vaccination, Veterans Health, health care access |
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