Disparities in pneumococcal and influenza immunization among older adults in Israel: A cross-sectional analysis of socio-demographic barriers to vaccination

Objective. Vaccinations against influenza and pneumonia reduce morbidity and mortality among older adults. We examined vaccination rates among Israel's diverse geriatric population to determine socio-demographic barriers to vaccination. Methods. This study is a quantitative data analysis with a cross-sectional design, comprising 136,944 patients aged 65 and older enrolled during 2008-2009 in the Maccabi Healthcare Services, one of Israel's four sick funds (preferred provider organizations). We conducted multivariable logistic regression analyses to determine the association between vaccination status and socio-demographic characteristics, including age, gender, rural residency, socio-economic status, region of origin, immigrant status, and Holocaust survivorship. We controlled for potential confounders, including comorbidities, primary care visits and hospitalizations, as well as the physician's gender and region of origin. Results. Overall, vaccination rates were 72% for pneumonia and 59% for influenza. The strongest socio-demographic barriers to vaccination included female gender, rural residency, low socio-economic status, recent immigration, and being from or having a physician from the Former Soviet Union. Conclusion. Efforts to further explore barriers to influenza and pneumococcal vaccination and interventions to reduce disparities in vaccination rates should focus on the sub-groups identified in this paper, with careful thought being given as to how to overcome these barriers. (C) 2013 Elsevier Inc. All rights reserved.