摘要：Objectives . This study examined whether differences in access to health care, health coverage, and socioeconomic status (SES) explained racial differences in influenza and pneumococcal vaccination rates in individuals with diabetes. Methods . We analyzed data on 1906 individuals from the 1998 National Health Interview Survey. We used multiple logistic regression to adjust for race/ethnicity, age, access to care, health insurance, and SES, and used SUDAAN for statistical analyses to yield national estimates. Results . Whites had higher vaccination rates than did African Americans or Hispanics. After adjustment for covariates, race/ethnicity predicted receipt of both vaccines independent of age, access to care, health care coverage, and SES. Conclusions . Racial disparity in vaccination rates for adults with diabetes is independent of access to care, health care coverage, and SES. (Am J Public Health. 2003;93:324–329) Diabetes mellitus is a chronic debilitating illness that affects about 16 million people in the United States. 1 Diabetes is more prevalent in minority populations, and complication and death rates from diabetes are higher in African Americans and Hispanics than in Whites. 1 Individuals with diabetes are susceptible to influenza and pneumonia, 2, 3 and they have higher death rates during episodes of influenza epidemics compared with people without diabetes. 4, 5 Influenza and pneumococcal vaccines are efficacious 6, 7 and cost-effective, 8– 10 and current guidelines recommend influenza and pneumococcal vaccination for people with diabetes. 11– 13 Also, Healthy People 2010 has set target vaccination rates for adults with diabetes at 65% for individuals younger than 65 years and 90% for those 65 years and older. 14 Regrettably, vaccination rates for people with diabetes are a long way from this objective, notably in African Americans and Hispanic. 15, 16 Socioeconomic status (SES) and unequal access to health care 15 are thought to contribute to disparities in vaccination rates. Debate on this topic parallels the debate in the larger field of racial/ethnic disparity research about the contribution of differential access to care and SES to racial inequities in health outcomes in the United States. 17– 19 We examined data from the 1998 National Health Interview Survey to determine whether differences in access to care, health care coverage, and SES explained racial/ethnic differences in immunization rates. Our hypothesis was that differences in access to care, health care coverage, and SES would explain racial disparities in influenza and pneumococcal vaccination rates in adults with diabetes.
