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Researchers seek to understand what factors affect vaccine uptake
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Researchers seek to understand what factors affect vaccine uptake

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Immunization Update

Jon​athan Little, PharmD

Illustration of a minority patient receiving a vaccination.

Describing the various sociodemographic disparities that may be associated with vaccine uptake can be difficult, but a study published on November 11, 2022, in JAPhA characterizes differences in disease burden, and sociodemographic and lifestyle characteristics for cohorts of participants who received certain common vaccines.

“Consistent with previous literature, minority participants had lower vaccination rates for all vaccines included with the exception of pneumococcal vaccination in patients under age 65 [years],” said Keri Hurley-Kim, PharmD, MPH, lead author of the study and clinical professor at the University of California at Irvine School of Pharmacy & Pharmaceutical Sciences.

In an effort to describe differences between the entire database cohort and smaller cohorts of recipients for influenza, hepatitis B (HBV), pneumococcal, and HPV vaccines, researchers analyzed data from the NIH All of Us (AoU) database, which contains hundreds of thousands of adult subjects’ metrics.

The authors outlined several characteristics of the groups who received these vaccines, such as age, insurance status, employment, annual household income, health status (e.g., comorbidities), and lifestyle behavior.

Setting this one apart from other studies, researchers used a single large database to look at multiple vaccines as opposed to focusing solely on one characteristic related to one vaccine as many other studies do.

“There is evidence to suggest that racial and ethnic minority groups receive vaccinations at lower rates overall compared to those of non-Hispanic white backgrounds,” Hurley-Kim said. “However, existing literature was based on surveys or vaccine administration records, both of which lack many demographic, lifestyle, and health-related variables. The AoU database contains all of this information, so it presented a new methodology for examining the interplay between various factors and their impact on vaccination status.”


Individuals included in the research cohorts were those who received a flu vaccine in the 2017–2018 flu season and those who received any of the other vaccines (HBV, pneumococcal, HPV) at least once in their lifetime prior to December 1, 2018. The entire research cohort in the AoU at the time of analysis was roughly 315,000 participants, and the size of the vaccine cohorts studied ranged from about 2,000 patients to 15,000 patients.

The researchers found that all vaccine cohorts had higher proportions of white and non-Hispanic/Latino participants than the general AoU cohort. This finding may suggest that non-white or Hispanic/Latino individuals may be less likely to receive vaccines than white and non-Hispanic/Latino individuals. This is a key finding that also demonstrates that the AoU database can be useful in studying vaccination rates in minority populations.

Additionally, higher apparent vaccination rates were found in Black participants in the cohort of patients under 65 years who received the pneumococcal vaccine, and this cohort also had the worst self-reported physical health. To be indicated for a pneumococcal vaccine at age 65 years or younger typically means the individual may have diabetes, chronic respiratory illness, or cardiovascular disease.

Going beyond

According to the study findings, all vaccine groups had higher proportions of participants with health insurance compared to the general AoU cohort. This underscores the importance of having insurance to pay for vaccines.

Pharmacists can help individuals without health insurance receive certain vaccines through nontraditional methods such as public health fairs or pharmacy school vaccine initiatives.

As the authors note, the findings from this research are in alignment with the literature on vaccine disparities.

“This study provides further information on racial and ethnic vaccine-related disparities and may help inform interventions to address these,” said Hurley-Kim. “It also serves as the basis for ongoing follow-up research looking at disparities in pneumococcal vaccination rates among participants with chronic diseases.”

Becoming better educated on these characteristics helps pharmacists know who may be less likely to receive certain vaccines, and who they can engage in discussions about the importance of vaccines. Pharmacists may then implement strategies such as increased outreach, provision of education, motivational interviewing, and more, to help their patients receive needed vaccinations. ■



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