FACTORS AFFECTING DISPARITIES IN INFLUENZA VACCINATION AMONG MEDICARE ELDERLY

影响医保老年人流感疫苗接种差异的因素

• 批准号: 8510504
• 负责人: Byung-Kwang Yoo
• 金额: $ 7.7万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-01 至 2015-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8510504
• 关键词: Affect; African American; Behavioral; Cessation of life; Cross-Sectional Studies; Disease Outbreaks; Dose; Elderly; Enrollment; Epidemic; Ethnic Origin; Ethnic group; Goals; Health Personnel; Healthcare; Healthy People 2020; Hispanic Americans; Hispanics; Individual; Influenza; Influenza A Virus, H1N1 Subtype; Influenza vaccination; Length of Stay; Manufacturer Name; Measures; Medicare; Modeling; Not Hispanic or Latino; Policy Maker; Population; Race; Reporting; Research; Risk; Seasons; Severities; Subgroup; Surveys; Time; Vaccination; Vaccines; aged; base; beneficiary; burden of illness; cohort; improved; influenza epidemic; influenza outbreak; influenza virus vaccine; meetings; pandemic disease; pandemic influenza; public health relevance; racial and ethnic; racial and ethnic disparities; response; seasonal influenza; time interval

DESCRIPTION (provided by applicant): Influenza imposes a substantial disease burden among the US elderly aged 65 or older, resulting in 33,000 deaths annually. To help reduce this serious disease burden, Healthy People 2020 sets the goal of a 90 percent influenza vaccination rate among the elderly, whose vaccination rate seems to have reached a plateau of ~ 70 percent during the early 2000s. Healthy People 2020 also aims to eliminate racial/ethnic disparities in vaccination rates among subgroups. This is because lower influenza vaccination rates are consistently reported among Hispanic and African American elderly, compared to non-Hispanic White elderly. Our findings will help policy-makers and healthcare leaders (I) allocate vaccine more efficiently in the short-term and (II) stabilize vaccine supply in the long-term. This will contribute to the Healthy People 2020 goals described above. Specifically, this study will predict influenza vaccine demand and identify key factors potentially contributing to racial/ethnic disparities in influenza vaccination. These factors include vaccine supply shortage and an individual behavioral response to avoid influenza-related risk (called avoidance response in this application), which can change during a single season. We will focus on vaccine supply shortage because our prior study revealed a strong "dose-response" association between more serious vaccine supply delay/shortage and greater racial/ethnic disparities among the US elderly population. Avoidance response is exemplified by an increase in influenza vaccine receipt after an observed increase in influenza epidemic activity. This time interval was empirically measured for both short-term (e.g., two weeks) and long-term (e.g., one year) time periods. Measuring avoidance response is useful in predicting both short-term and long-term influenza vaccine demand which may fluctuate, even within a single season, due to various causes. For instance, our model could predict state-specific influenza vaccine demand in the coming weeks based on the state-specific epidemic activity of the past weeks; this state-specific prediction could help improve "short-term" vaccine allocation across states. Our model will also predict long-term vaccine demand so healthcare providers and manufacturers will be better able to anticipate and meet the coming season's ("long-term") demand. Further detailed predictions for each race/ethnicity group can be made with our model. The specific aims of the research plan are: 1) To assess whether racial/ethnic disparities in seasonal influenza vaccination worsened during the 2009-2010 season, in which serious seasonal influenza vaccine supply shortages occurred due to the pandemic (H1N1) influenza, compared to either the preceding (2008-2009) season or the subsequent (2010-2011) season. We will analyze the same cohort of Medicare beneficiaries aged e65 (enrolled in the nationally representative Medicare Current Beneficiary Survey (MCBS)). 2) To examine if the magnitude of avoidance response differs across racial/ethnic groups during a single season. 3) To develop a model for predicting the short and long-term demand for influenza vaccine, using results from aims 1 and 2.

描述（由申请人提供）：流感给 65 岁或以上的美国老年人带来了沉重的疾病负担，每年导致 33,000 人死亡。为了帮助减轻这种严重的疾病负担，《健康人民 2020》设定了老年人流感疫苗接种率达到 90% 的目标，而老年人的疫苗接种率在 2000 年代初似乎已达到约 70% 的稳定水平。 《健康人民 2020》还旨在消除亚群体之间疫苗接种率的种族/民族差异。这是因为与非西班牙裔白人老年人相比，西班牙裔和非裔美国老年人的流感疫苗接种率一直较低。 我们的研究结果将帮助政策制定者和医疗保健领导者（一）在短期内更有效地分配疫苗；（二）长期稳定疫苗供应。这 将为上述“健康人类 2020”目标做出贡献。具体来说，这项研究将预测流感疫苗需求并确定可能导致种族/民族的关键因素 流感疫苗接种的差异。这些因素包括疫苗供应短缺和避免流感相关风险的个人行为反应（在本申请中称为回避反应），这些反应可能在单个季节内发生变化。我们将重点关注疫苗供应短缺，因为我们之前的研究表明，更严重的疫苗供应延迟/短缺与美国老年人口中更大的种族/民族差异之间存在很强的“剂量反应”关联。 回避反应的例子是在观察到流感流行活动增加后，流感疫苗接种量增加。该时间间隔是根据经验测量短期（例如两周）和长期（例如一年）时间段的。测量回避反应有助于预测短期和长期流感疫苗需求，这些需求可能由于各种原因而波动，甚至在一个季节内也是如此。例如，我们的模型可以根据过去几周各州特定的流行病活动来预测未来几周各州特定的流感疫苗需求；这种针对各州的预测可能有助于改善各州之间的“短期”疫苗分配。我们的模型还将预测长期疫苗需求，因此医疗保健提供者和制造商将能够更好地预测和满足即将到来的季节（“长期”）需求。可以使用我们的模型对每个种族/族裔群体进行更详细的预测。 研究计划的具体目标是： 1) 评估季节性流感疫苗接种方面的种族/民族差异是否在 2009-2010 年季节期间加剧，其中由于大流行 (H1N1) 流感而出现严重的季节性流感疫苗供应短缺，与前一季 (2008-2009) 或后一季 (2010-2011)。我们将分析年龄为 65 岁的同一组 Medicare 受益人（参加了具有全国代表性的 Medicare 当前受益人调查 (MCBS)）。 2) 检查单个季节内不同种族/族裔群体的回避反应程度是否不同。 3) 利用目标 1 和 2 的结果，开发一个模型来预测流感疫苗的短期和长期需求。