Black nursing home patients are less likely to receive flu vaccinations than white patients, according to a study published Oct. 5. in the journal Health Affairs. The data, gathered between 2006 and 2009, encompass more than 14,000 nursing homes across the country.
While 83.5 percent of white nursing home patients received flu vaccinations in 2009, 77.8 percent of black patients received the vaccines. Neither subset satisfies the federal Center for Medicaid and Medicare's goal of 90 percent vaccination.
The study's lead author Shubing Cai, an investigator in health services, policy and practice at Brown's Center for Gerontology and Health Care Research, speculates the disparity might exist because the administration of flu vaccines is optional, and black patients are more likely to refuse. Cai suggested black patients may have misconceptions and fears about flu vaccinations due to their educational and societal backgrounds.
But she maintained the difference was not caused by racial discrimination. Many nursing homes serving predominantly black patients have predominantly black staff as well. Thus, attributing the problem to racial discrimination presents a false solution.
Instead, Cai stressed the importance of improving nursing home facilities in poor neighborhoods and providing more information on the benefits of flu vaccines. "Blacks are more likely to refuse the vaccine, but we did not have any information about why," she said.
She outlined some strategies for reducing the disparity, including improving communication between nursing home workers and black patients. She stressed the need for more awareness of the benefits of vaccination and advocated more educational programs in nursing homes.
Nursing homes serving a higher proportion of blacks are likely to be in worse neighborhoods than those serving a predominantly white population, according to the study. "Those nursing homes have an overall worse quality of care," Cai said. "They are very likely to be in a poor community and have a lack of resources."
The study proposes the idea of an incentive structure to motivate nursing home facilities to provide more vaccinations, but more research would be necessary for effective implementation.
There have been slight improvements in recent years in the percentage of flu vaccinations given to nursing home patients, especially blacks, the study reports. But Cai was not convinced the problem would subside. "In spite of the improvement, we can still see a racial disparity," she said. Though the data show improvement, disparity between races still hovers around 6 percent each year.
