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- Table 1.
Partial List of Factors from the Literature That Are Significantly Correlated with Rates of Influenza Immunizations
Demographic Factors Increases Flu shot rates Higher educational level2 Increased age2,3 Male and married2 Increasing household income3 Health care worker in family4 Decreases flu shot rates Spanish-speaking5 Lack of health insurance3 African-American1,3 Hispanic1 Living alone6 Not having a driver6 Health Status and Behaviors Increases flu shot rates Non-smoker3 Previous vaccination7 Greater disease burden2 Fair or poor health status3 Vigorous exerciser3 Decreases flu shot rates Previous flu shot side effects3 Cognitive impairment3 Being healthier4,8 Health Service Use Increases flu shot rates Office visit during flu season9 PCP discussed flu shots10 3+ doctors visits in a year3 Doctor recommendation11,12 VA patient11,13 Decreases flu shots Patient of inner city clinic11,13 Health System Organization Increases flu shot rates Computer reminder to doc14,15 Walk-in vaccine clinics13,16,17 Standing vaccine orders16,17 Mailed patient reminders16–20 Action-oriented pt reminder18 Urban practice19 - Table 2.
Demographics of Study Subjects and Significance of Differences between Those Who Did and Those Who Did Not Receive Flu Shots (n = 6110)
Total Population (mean/percent) Subjects Who Received Flu Shot in 1998 (mean/percent) Subjects Who Did Not Receive Flu Shot in 1998 (mean/percent) t Test/χ2, P Value Age 76.1± 6.9 76.3± 7 75.4 ± 7 t = 4.7, <.01 Percent female 57.7% 57.1% 59% NS Percent African American 8.6% 6.2% 14.1% χ2 = 101, <.01 Percent Hispanic 6.6% 5.5% 9.3% χ2 = 29, <.01 Household income $26,522± $36,150 28,017± 30,393 23,071± 46,873 t = 4.9, <.01 Highest level of education* 4.4± 2.3 4.7± 2.1 4.0± 2 t = 10.4, <.01 Percent currently married 52.7% 55.1% 47.1% χ2 = 33, <.01 Percent living in metro area 72.1% 71.3% 74.2% χ2 = 5.6, <.05 * 1, no schooling; 2, 1–8th grade; 3, 9–12th grade, no diploma; 4, high school graduate; 5, voc tech bus grad; 6, some college, no degree; 7, associates degree; 8, bachelor degree; 9, graduate degree.
- Table 3.
Health Status and Health Behaviors of Subjects Who Did and Did Not Receive Flu Shots (n = 6110)
Total Population (mean/percent) If Received Flu Shot in 1998 (mean/percent) If Did Not Receive Flu Shot in 1998 (mean/percent) t Test, P Value Percentage of current smokers 11% 8.9% 15.7% χ2 = 61, <.01 Number of chronic diseases (max = 15)* 2.3± 1.6 2.4± 1.6 2.0± 1.5 t = 10.4, <.01 Level of disability† 2.5± 1.1 2.6± 1.1 2.5± 1.1 t = 3.1, <.01 Self-reported health status‡ 2.7± 1.1 2.7± 1.1 2.7± 1.1 NS Saw any physician in 1998 (non-HMO)§ 90% 94% 83% χ2 = 135, <.01 No. of total physician claims in 1998 (non-HMO)§ 27± 32 30± 33 20± 30 t = 94, <.01 Saw pcp in 1998 (non-HMO)§ 74% 78% 65% χ2 = 83, <.01 No. of primary care physicians claims in 1998 (non-HMO patients)§ 9± 12 9.9± 13 6.5± 11 t = 91, <.01 Saw specialist in 1998 (non-HMO patients)§ 84.4% 88% 75% χ2 = 136, <.01 No. of specialist claims in 1998 (non-HMO patients)§ 18± 27 19± 27 14± 25 t = 7.2, <.01 HMO enrollment in 1998 20.3% 21% 18.5% χ2 = 5.2, <.05 * High blood pressure, previous myocardial infarction, angina/ischemic heart disease, stroke, cancer, diabetes, arthritis, osteoporosis, broken hip, psychiatric illness, Alzheimer disease, Parkinson disease, chronic obstructive pulmonary disease/emphysema, paralysis, amputation.
† 1, none; 2, nagi limitation; 3, iadl limitation; 4, adl limitation.
‡ 1, excellent; 2, very good; 3, good; 4, fair; 5, poor.
§ 4876 patients were non-HMO patients and had line item claim data available.
- Table 4.
Logistic Regression of Factors Significantly Associated with Flu Shot in the Current Year (1998)*†
Variable Beta Wald Statistic df P Value Constant 4.829 110 1 <.01 Disease burden −0.187 80 1 <.01 Level of education −0.127 59 1 <.01 African American −0.699 49 1 <.01 HMO member 0.475 34 1 <.01 Current smoker −0.471 27 1 <.01 Married 0.296 21 1 <.01 Age −0.20 19 1 <.01 Urban resident −0.270 15 1 <.01 No. of primary care provider claims −0.014 12 1 <.01 Hispanic ancestry −0.368 11 1 <.01 Total no. of physician claims −0.005 9 1 <.01 Household income 0.00 6 1 <.05 * Flu shot: yes = 0, no = 1; for all categorical variables (African American, Hispanic ancestry, smoking, married?, HMO membership, living in urban area) yes = 0, no = 1.
† Variables not statistically significant in the model: self-reported health status, level of disability, and number of specialist physician claims.
- Table 5.
Logistic Regression of Factors (excluding flu shot status in 1998) Significantly Associated with Flu Shot in the Subsequent Year (1999)*‡
Variable Beta Wald Statistic df P Value Disease burden −0.169 65 1 <.01 Level of education −0.122 53 1 <.01 HMO member in 1998 0.600 52 1 <.01 African American −0.686 47 1 <.01 No. of primary care claims −0.023 29 1 <.01 Current smoker −0.479 28 1 <.01 Married? 0.283 19 1 <.01 Age −0.018 15 1 <.01 Hispanic ancestry −0.394 12 1 <.01 Urban resident −0.240 12 1 <.01 Household income 0.00 7 1 <.05 Total no. of physician claims −0.004 6 1 <.05 Constant 4.635 101 1 <.01 * Flu shot: yes = 0, no = 1; for all categorical variables (African American, Hispanic ancestry, smoking, married?, HMO membership, living in urban area) yes = 0, no = 1.
‡ Variables not statistically significant in the model: self-reported health status, level of disability, and number of specialist physician claims. R square of model = 0.115.
- Table 6.
Logistic Regression of Factors (including flu shot status in 1998) Significantly Associated with Flu Shot in the Subsequent Year (1999)*†
Variable Beta Wald Statistic df P Value Flu shot in 1998 4.073 2101 1 <.01 No. of primary care provider claims in 1998 −0.022 24 1 <.01 HMO member in 1998 0.470 16 1 <.01 Level of education −0.075 12 1 <.01 African American −0.382 6 1 <.05 Current smoker −0.321 6 1 <.05 Disease burden −0.059 4 1 <.05 Constant −4.661 124 1 <.01 * Flu shot: yes = 0, no = 1; for all categorical variables (African American, Hispanic ancestry, smoking, married?, HMO membership, living in urban area) yes = 0, no = 1.
† Variables not statistically significant in the model: total number of physician claims, marital status, age, Hispanic ancestry, household income, self-reported health status, level of disability, living in an urban area, and number of specialist physician claims. R square of model = 0.64.
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