- Email: [email protected]
Low Immunization Rates in Ethnic Minorities–A Problem Pharmacists Can Help Solve
VACClNE UPDATE
Immunization Rates in Ethnic MinoritiesA Problem Pharmacists Can Help Solve LO\N
John D. Grabenstein
Question: I've heard about differences in immunization rates based on race or ethnic group. What are the statistics, and what can be done to close the gaps? Answer: African Americans and Hispanic Americans are less likely to be immunized, compared with whites. The gap is 2% to 7% for preschool children, and 9% to 17% for adults. I Racial differences in vaccinating children are accounted for, in part, by differences in socioeconomic status, the presence or lack of a routine source of health care, marital status, maternal education, maternal age, family size, and proximity of the maternal grandmother. Other factors include foreign birth, access to transportation, and personal beliefs about vaccine efficacy, vaccine side effects, and disease susceptibility. In some groups, childhood immunization rates remain low even when vaccines are provided without direct cost. l In recent years, differences in childhood immunization rates by race or ethnic group have narrowed substantially, on average. But some population clusters, sometimes called pockets of need, still have dangerous shortfalls in childhood vaccine delivery. 1
708
The problem of underimmunization in some ethnic groups is especially tragic among adults. Both the attack rate and the case-fatality rate for pneumococcal bacteremia are higher among African American adults than among whites. Vaccine-preventable deaths due to Streptococcus pneumoniae and influenza virus strike people in minority groups disproportionately.l-3 The National Coalition for Adult Immunization4 lists four main reasons for the discrepancy in immunization rates between white adults and adults in ethnic minorities: restricted access to care or lack of insurance coverage; low motivation of primary care providers to recommend immunization to minorities; missed opportunities to immunize during health care encounters; and family factors (e.g. , education, family size, poverty, frequent moves, language barriers, undocumented immigrant status, inadequate awareness of vaccine-preventable diseases, misconceptions about vaccine efficacy or side effects). Overall, members of minority groups are less likely to be offered immunization and less likely to accept it when offered. l,4 Human factors are more
Journal of the American Phannaceutical Association
important than fi nancial factors in these situations. After all, Medicare pays for both pneumococcal and influenza vaccination of the elderly, regardless of ethnicity. How can pharmacists help to raise immunization rates in all population groups? Several studies show that when trusted health care professionals offer immunizations, acceptance rates increase. s Shortfalls in immunizations among African Americans will not be solved by African American pharmacists alone. Shortfalls among Hispanic Americans will not be solved by Hispanic American pharmacists alone. These dangerous gaps will be overcome only when pharmacists and other health care professionals actively and consistently recommend immunizations to all of their patients. Passive ways to communicate the importance of immunizations include posters, buttons, bag stuffers, and the like. But nothing is more persuasive than the personal interest of the pharmacist: asking each patient whether his or her family is fully vaccinated should become a matter of routine. Verbal recommendations do not have to be time consuming, if accompanied by a copy of the current immunization schedule or other written materials. Effective one-liners include, "Don't forget to get pneumococcal vaccine along with your flu shot this year," and "Have you checked your family 's vaccine coverage lately?" Partners in vaccine advocacy can be found at each local health department. Ask them how you can help support their vaccine outreach
efforts to benefit your neighbors. Or check the resources of the Immunization Action Coalition at 651-647-9009 or www.immunize.org.
References 1. Grabenstein JO. Overcoming immunization disparities based on race and ethn icity. Hosp Pharm. 1999;34:550,553-6,559. 2.
Bennett NM, Bu ffington J, LaForce FM. Pne umococcal bacteremia in Mo nroe Coun· ty, New York . A m J Public Health. 1992;82:1513-6.
3.
Filice GA. Pneumococcal vaccines and public health policy: consequences o f missed opportunities. A rch Intern Med. 1990;150:1373-5.
4
National Coalition for Adult Immunization . Improving Influenza and Pne umococcal Immunization Rates Among High-Risk Adults . Bethesda, MD: National Co alition for Adult Immunizatio n; October 1998.
5. Centers for Disease Control and Prevention. Ad ult immu· nization: knowledge, attitudes, and practices, DeKal b and Fulton Counties, Georgia, 1988. MMWR. 1988;37 :657-61.
Lt. Col. John D. G rabenstein, PhD, FASHP, is pha rmacoepi· demiologist, U.S. Army Medical Command, Falls Chu rch, Va.
Send your immunization questions to Lt. Col. John D. Grabenstein, PhD, FASHP, U.S. Army Medical Command, 511 Leesburg Pike, Falls Church, VA 22041 . The assertions contained herein are the private view of the author. They should not be construed as official or reflecting the views of the U.S. Department of Defense or the Department of the Army.
September/October 1999
Vo1.39,
0. 5
Immunization Rates in Ethnic MinoritiesA Problem Pharmacists Can Help Solve LO\N
John D. Grabenstein
Question: I've heard about differences in immunization rates based on race or ethnic group. What are the statistics, and what can be done to close the gaps? Answer: African Americans and Hispanic Americans are less likely to be immunized, compared with whites. The gap is 2% to 7% for preschool children, and 9% to 17% for adults. I Racial differences in vaccinating children are accounted for, in part, by differences in socioeconomic status, the presence or lack of a routine source of health care, marital status, maternal education, maternal age, family size, and proximity of the maternal grandmother. Other factors include foreign birth, access to transportation, and personal beliefs about vaccine efficacy, vaccine side effects, and disease susceptibility. In some groups, childhood immunization rates remain low even when vaccines are provided without direct cost. l In recent years, differences in childhood immunization rates by race or ethnic group have narrowed substantially, on average. But some population clusters, sometimes called pockets of need, still have dangerous shortfalls in childhood vaccine delivery. 1
708
The problem of underimmunization in some ethnic groups is especially tragic among adults. Both the attack rate and the case-fatality rate for pneumococcal bacteremia are higher among African American adults than among whites. Vaccine-preventable deaths due to Streptococcus pneumoniae and influenza virus strike people in minority groups disproportionately.l-3 The National Coalition for Adult Immunization4 lists four main reasons for the discrepancy in immunization rates between white adults and adults in ethnic minorities: restricted access to care or lack of insurance coverage; low motivation of primary care providers to recommend immunization to minorities; missed opportunities to immunize during health care encounters; and family factors (e.g. , education, family size, poverty, frequent moves, language barriers, undocumented immigrant status, inadequate awareness of vaccine-preventable diseases, misconceptions about vaccine efficacy or side effects). Overall, members of minority groups are less likely to be offered immunization and less likely to accept it when offered. l,4 Human factors are more
Journal of the American Phannaceutical Association
important than fi nancial factors in these situations. After all, Medicare pays for both pneumococcal and influenza vaccination of the elderly, regardless of ethnicity. How can pharmacists help to raise immunization rates in all population groups? Several studies show that when trusted health care professionals offer immunizations, acceptance rates increase. s Shortfalls in immunizations among African Americans will not be solved by African American pharmacists alone. Shortfalls among Hispanic Americans will not be solved by Hispanic American pharmacists alone. These dangerous gaps will be overcome only when pharmacists and other health care professionals actively and consistently recommend immunizations to all of their patients. Passive ways to communicate the importance of immunizations include posters, buttons, bag stuffers, and the like. But nothing is more persuasive than the personal interest of the pharmacist: asking each patient whether his or her family is fully vaccinated should become a matter of routine. Verbal recommendations do not have to be time consuming, if accompanied by a copy of the current immunization schedule or other written materials. Effective one-liners include, "Don't forget to get pneumococcal vaccine along with your flu shot this year," and "Have you checked your family 's vaccine coverage lately?" Partners in vaccine advocacy can be found at each local health department. Ask them how you can help support their vaccine outreach
efforts to benefit your neighbors. Or check the resources of the Immunization Action Coalition at 651-647-9009 or www.immunize.org.
References 1. Grabenstein JO. Overcoming immunization disparities based on race and ethn icity. Hosp Pharm. 1999;34:550,553-6,559. 2.
Bennett NM, Bu ffington J, LaForce FM. Pne umococcal bacteremia in Mo nroe Coun· ty, New York . A m J Public Health. 1992;82:1513-6.
3.
Filice GA. Pneumococcal vaccines and public health policy: consequences o f missed opportunities. A rch Intern Med. 1990;150:1373-5.
4
National Coalition for Adult Immunization . Improving Influenza and Pne umococcal Immunization Rates Among High-Risk Adults . Bethesda, MD: National Co alition for Adult Immunizatio n; October 1998.
5. Centers for Disease Control and Prevention. Ad ult immu· nization: knowledge, attitudes, and practices, DeKal b and Fulton Counties, Georgia, 1988. MMWR. 1988;37 :657-61.
Lt. Col. John D. G rabenstein, PhD, FASHP, is pha rmacoepi· demiologist, U.S. Army Medical Command, Falls Chu rch, Va.
Send your immunization questions to Lt. Col. John D. Grabenstein, PhD, FASHP, U.S. Army Medical Command, 511 Leesburg Pike, Falls Church, VA 22041 . The assertions contained herein are the private view of the author. They should not be construed as official or reflecting the views of the U.S. Department of Defense or the Department of the Army.
September/October 1999
Vo1.39,
0. 5