Barbara Bardenheier^,, Stefan Gravenstein, Carolyn Furlow, Faruque Ahmed, Carol J. Rowland Hogue

Nursing home racial composition is associated with vaccine uptake; black residents are less well immunized than white residents. To determine if health status modifies the effect of race on receiving vaccination among nursing home residents, we used cross-sectional data from the Centers for Medicare & Medicaid Services for Michigan from October 1, 2005 through March 31, 2006 in 291 racially mixed nursing facilities (n=66,895 residents). Analyses included multilevel models, stratified by the proportion of black residents in the nursing home, to assess whether frailty, measured with the Cognitive Performance Scale (CPS), the Activities of Daily Living (ADL), and the Changes in Health, End-stage disease and Symptoms and Signs (CHESS), contributed to vaccination inequity (i.e., white-black difference) within nursing homes. In facilities with few (<5%) blacks, the median vaccination inequity increased when comparing non-frail to frail (CPS) residents: from 4.4 to 14.5 percentage points; ADL: 3.6 to 8.7; and CHESS: 4.1 to 9.4. Among residents of nursing homes with majority (> 50%) blacks, the inequity decreased with increasing frailty (CPS: 8.7 to 0.8; ADL: 9.3 to 2.1; and CHESS: 6.7 to 4.6). Frail residents of minority status within a facility were less likely to be vaccinated than either healthier minority status residents or majority status residents, frail or healthy.

vaccination, nursing home, frailty, racial inequity