The Impact of Racial and
Ethnic Disparities in Influenza
Vaccination on Minority
Deaths
Kevin Fiscella, MD, MPH
Departments of Family Medicine
Community & Preventive Medicine
University of Rochester School of Medicine & Dentistry
Goals of Study
• Estimate the impact of racial and ethnic
disparity in flu shots on elderly, minority
deaths and lives saved by achievement of
HP 2010 vaccination rates.
• Illustrate a method for quantifying the
impact of health care disparities on
disparities in health.
Annual All-Cause Deaths among
Elderly from Influenza
• 46,000 (range 23,000-64,000) –CDC, 2003
• Racial and ethnic disparities in influenza
vaccination are striking (W 67%, B 46%, H 55%)
• Impact of disparities in vaccination on elderly
minority deaths is not known
Methods
• Estimate the number of influenza associated
all-cause deaths attributable to influenza
among elderly minority patients (both
vaccinated and unvaccinated).
• Simulate the number of influenza associated
all-cause deaths assuming equivalence
between white, non-Hispanic and minority
rates.
Influenza Vaccination Rates (MCBS, 2002)
Percent Vaccinated
Sex/race/ethnicity 65-74 ys
75-84 yrs
> 85 yrs
White Male
65
78
78
White Female
67
74
75
Black Male
53
59
70
Black Female
54
51
60
Hispanic Male
60
66
56
Hispanic Female
44
55
65
Estimate of Reduction in AllCause Mortality from Flu Shots
• Meta-analysis of cohort studies show a 68%
reduction in all-cause mortality (not just flu
related!) among elderly vaccinated patients.
• Estimate is improbably high – vastly exceeds the
number of deaths CDC attributes to influenza.
• Selection bias confounds estimates.
Comparison of Deaths During Influenza
and Non-influenza Season among
Vaccinated and Unvaccinated
(Armstrong et al 2004)
• Minimizes selection bias
• Vaccination reduces influenza attributable
risk percent from 13.4% to 2.2%
Estimating deaths
deaths in age, gender, race/ethnicity
subgroup = annual deaths x PAR x number
in subgroup x #months flu/12
Estimating deaths under varying flu shot
rates
Validation in U.S.
Applying these estimates to 1998-1999 US
data approximates CDC estimates of elderly
flu deaths (60,230 v. 58,820)
Total and influenza associated deaths
among elderly minorities, 2002
Minority
Group
Total deaths
Flu-Associated
deaths
African
Americans
162,500
5,890
Hispanics
64,600
2,220
Minority lives saved from increases in vaccination
rates v. deaths from 10th leading cause
Minority
Group
Lives saved
under
vaccination
equity
Lives saved
with HP
2010
objective
African
Americans
1,520
3,050
Deaths
from 10th
leading
cause of
death
2,960
Hispanics
610
1,200
1,070
Minority Years of Life Saved
Minority
Group
YLS under
vaccination
equity
YLS with HP
2010 objective
African
Americans
Hispanics
12,600
27,100
5,690
11,630
Total
18,290
38,730
Limitations of findings
• Uncertainty regarding impact of influenza
vaccination on mortality
• Uncertainty as comparable attributable risk
of influenza among different groups or
comparable benefit of vaccine.
Conclusions
• Racial and ethnic disparities in flu shot contribute
appreciably to minority deaths.
• Achievement of 90% vaccination coverage for
minorities would save more minority lives than
elimination of the 10th leading cause of deaths.
• Deaths resulting from disparities in health care
represent one means for quantifying the impact of
health care disparities on minority health.
Acknowledgments
• Richard Dressler, MD, MPH
• Kathleen Holt, PhD
• RWJF for support