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Schneider EC, Cleary PD, Zaslavsky AM, Epstein AM. Racial Disparity in Influenza Vaccination: Does Managed Care Narrow the Gap Between African Americans and Whites? JAMA. 2001;286(12):1455–1460. doi:10.1001/jama.286.12.1455
Author Affiliations: Department of Health Policy and Management, Harvard School of Public Health, and Division of General Medicine, Brigham and Women's Hospital (Drs Schneider and Epstein), and Department of Health Care Policy, Harvard Medical School (Drs Cleary and Zaslavsky), Boston, Mass.
Context Substantial racial disparities exist in use of some health services.
Whether managed care could reduce racial disparities in the use of preventive
services is not known.
Objective To determine whether the magnitude of racial disparity in influenza
vaccination is smaller among managed care enrollees than among those with
Design, Setting, and Participants The 1996 Medicare Current Beneficiary Survey of a US cohort of 13 674
African American and white Medicare beneficiaries with managed care and fee-for-service
Main Outcome Measures Percentage of respondents (adjusted for sociodemographic characteristics,
clinical comorbid conditions, and care-seeking attitudes) who received influenza
vaccination and magnitude of racial disparity in influenza vaccination, compared
among those with managed care and fee-for-service insurance.
Results Eight percent of the beneficiaries were African American and 11% were
enrolled in managed care. Overall, 65.8% received influenza vaccination. Whites
were substantially more likely to be vaccinated than African Americans (67.7%
vs 46.1%; absolute disparity, 21.6%; 95% confidence interval [CI], 18.2%-25.0%).
Managed care enrollees were more likely than those with fee-for-service insurance
to receive influenza vaccination (71.2% vs 65.4%; difference, 5.8%; 95% CI,
3.6%-8.3%). The adjusted racial disparity in fee-for-service was 24.9% (95%
CI, 19.6%-30.1%) and in managed care was 18.6% (95% CI, 9.8%-27.4%). These
adjusted racial disparities were both statistically significant, but the absolute
percentage point difference in racial disparity between the 2 insurance groups
(6.3%; 95% CI, –4.6% to 17.2%) was not.
Conclusion Managed care is associated with higher rates of influenza vaccination
for both whites and African Americans, but racial disparity in vaccination
is not reduced in managed care. Our results suggest that additional efforts
are needed to adequately address this disparity.
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