Black Teens Less Likely to Get Flu Shots Than Whites, Hispanics

Benjamin Dowd-Arrow, MS

Black teens in the US had 5% lower odds of getting an influenza (flu) vaccine shot than their white counterparts—and that gap is growing, according to a new study from Florida State University (FSU).

In an analysis that considered 7 years of vaccination histories from more than 117,000 adolescents aged 13 to 17, investigators found that Hispanic teens were comparatively 11% more likely to receive a flu vaccination than their white peers. But overall, this age group routinely had the lowest vaccination rates among all children under the age of 18.

“We would urge medical professionals to expand who they target for influenza vaccinations,” co-author Benjamin Dowd-Arrow, MS, a doctoral candidate at FSU, told MD Magazine®. “Most often we urge those 65 and older to get vaccinated, while we ignore other cohorts.”

Vaccinating children may reduce total flu cases, and the mortality and morbidity associated with flu-related illness. Achieving an 80% influenza uptake rate among children and adolescents would likely result in a 91% reduction in the number of influenza illness cases on a population-wide basis, the team wrote in their recently published study.

That message is especially important for black teens.

“Black adolescents and young adults consistently have worse health profiles than white and Hispanic adolescents and young adults,” Dowd-Arrow said. “The black population is also more likely to reside in multigenerational homes, where there is a very real threat of unvaccinated teenagers spreading the flu to unvaccinated children and grandparents.”

Until now, few studies have examined racial and ethnic trends in influenza vaccination rates among US adolescents. And there has been little feedback on racial/ethnic variations in influenza vaccination and mortality rates since the Patient Protection and Affordable Care Act (ACA) increased access to preventive health care, including immunizations, in 2010.

To investigate, Dowd-Arrow and colleagues considered a study sample of the 117,000-plyus adolescents from the teen portion of the National Immunization Survey, for the period 2010-2016. Investigators found that vaccination rates among all adolescents rose steadily in that time—from 19% in 2010, to 27% in 2014, before declining slightly to 26% in 2015 and 2016.

During that time, 24% of white adolescents received flu vaccinations. Among Hispanic adolescents, the percentage was 22.6%. Among black adolescents, 20.5% got a flu shot. After controlling for key demographic characteristics, Hispanics had higher influenza vaccination rates than white adolescents for much of the study period, Dowd-Arrow said.

That advantage tapered roughly midway through the study, and vaccine rates among white and Hispanic adolescents became similar. Dowd-Arrow suggested that the failure of states to execute on the Medicaid mandate of the Affordable Care Act resulted in the 2 groups having more and more similar rates.

More alarming, the gap between white and black adolescents who get vaccinated for the flu is growing—with no sign that this disparity will shrink anytime soon, he said.

Asked what might account for the difference, he cited 3 reasons: lack of health insurance, misinformation, and little trust in the social institutions providing the vaccines.

“If you are a family of four without insurance, the cheapest option (for flu shots) costs you $80,” Dowd-Arrow said. “For the poorest groups, lacking insurance may mean that flu vaccination is unaffordable.”

Further, many people still worry about vaccines causing autism or other illnesses, despite those outcomes being debunked. Black patients, specifically, face a long history of unethical medical procedures, such as the Tuskegee Experiments, Dowd-Arrow said. In comparison, newly immigrated Hispanics may be less exposed to misinformation surrounding the safety of vaccines and more likely to take advantage of new health-care options.

“Future research that accounts for nativity and Hispanic subgroups could help us tease out these findings,” Dowd-Arrow said.

In the meantime, the medical community should push for legislation to cut vaccine costs for those who can’t afford the price and provide more information on vaccine benefits to families in low income neighborhoods.

“They will be most at risk for the more devastating effects of the flu,” he said.

The study, “Racial/Ethnic Disparities in Influenza Vaccination Coverage Among US Adolescents, 2010-2016,” was published online in Public Health Reports.