Decomposing Racial and Ethnic Disparities in Nursing Home Influenza Vaccination

AbstractObjectives Quantify how observable characteristics contribute to influenza vaccination disparities among White, Black, and Hispanic nursing home (NH) residents. Design Retrospective cohort. Setting Participants Short- long-stay U.S. NH residents aged ≥65 years. Methods We linked Minimum Data Set (MDS) Medicare data LTCFocUS other facility data. included with 6-month continuous enrollment in an MDS assessment between October 1, 2013, March 31, 2014. Residents were classified as short-stay (<100 days NH) or (≥100 NH). fit multivariable logistic regression models assess the relationships 27 resident NH-level receipt of vaccination. Using nonlinear Oaxaca-Blinder decomposition, we decomposed disparity White versus Black Analyses repeated separately for short- Results Our study 630,373 1,029,593 Proportions vaccinated against 67.2% 55.1% 54.5% individuals 84.2%, 76.7%, 80.8%, respectively Across 4 comparisons, crude ranged from 3.4 12.7 percentage points. By equalizing prespecified characteristics, these could be reduced 37.7% 59.2%. Living a predominantly proxies quality important contributors across all analyses. Characteristics unmeasured our (eg, staff attitudes beliefs) may have also contributed significantly disparity. Conclusions Implications The racial/ethnic was most dramatic Intervening on factors associated would likely reduce disparities; however, future qualitative research is essential explore potential that understand degree which overall