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Disparities in Immunization Rates for Seniors by Hispanic Ethnicity and Spanish-Language Preference
Marc N Elliott, RAND Corporation 
Katrin Hambarsoomian, RAND Corporation 
*Amelia M Haviland, RAND Corporation 
Amy Heller, Health Policy Consulting 
Nicole Lurie, Department of Health and Human Services 


Prior research has found evidence of disparities in influenza and pneumococcal pneumonia immunization rates for Hispanic seniors. This raises particular concerns because the elderly are at high risk of serious health complications from these conditions. Better understanding of these disparities may help to focus interventions and may inform strategies to combat new viruses such as H1N1. We estimate current disparities in influenza and pneumococcal immunization for older English- and Spanish-preferring Hispanics relative to non-Hispanic Whites and investigate the roles of linguistic isolation, new vs. established destination communities, and managed care in these disparities. Analyses are carried out on data from 244,618 randomly sampled community-dwelling respondents aged 65 and older to the 2008 Medicare CAHPS survey. Additional geographic variables are derived from the American Community Survey. Weighted logistic regression estimated immunization disparities with and without adjustment for health status and socio-demographic variables related to access to care. Hierarchical models interpreted through recycled predictions examined the role of geographic factors in immunization disparities. Hispanic seniors, especially when Spanish-preferring and in linguistically isolated “new destinations,” such as the Southeast, continue to be immunized at markedly lower rates than non-Hispanic Whites, even after adjustment for health and socio-demographics. Individual physicians and policymakers, through cultural and linguistic aid and rapid influenza and demographic surveys, may be able to assist this vulnerable group.