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Social Determinants of Health

Shingles Vaccinations Rose Sharply in Past Decade, but Minorities Lag Far Behind

  • 1Consulting Editor, JAMA Health Forum and JAMA

The percentage of adults 60 years or older who are vaccinated against shingles soared nearly 5-fold in the past decade, but older Hispanic or Black individuals are only half as likely to receive the vaccine as their White counterparts.

About 35% of people 60 years or older had received a shingles vaccine at some point compared with not quite 7% in 2008, according to a new report from the Centers for Disease Control and Prevention. Although women and men in this age group were equally likely to have ever received a shingles vaccine (35.4% vs 33.5%, respectively), vaccination rates varied considerably depending on race or ethnicity, poverty status, educational attainment, and geographic characteristics.

A vaccine for shingles, the zoster live vaccine, became available in the United States in 2006 and is recommended for those 60 years or older. The substantially more effective recombinant zoster vaccine was introduced in late 2017, and the Advisory Committee on Immunization Practices expanded its recommendation for vaccination to adults 50 years or older. (This month, sales of the earlier vaccine were discontinued by the manufacturer.)

Using data from the National Health Interview Survey, the authors of the new report found that 38.6% of non-Hispanic White adults had ever received a shingles vaccine compared with 18.8% of non-Hispanic Black adults and 19.5% of Hispanic adults. Such disparities, though generally less pronounced, also exist for other adult vaccines, including influenza and pneumonia vaccines.

A recent Kaiser Health News article notes that lower vaccination rates for Black and Hispanic people, and the reasons for those lower rates, might have implications for immunization for coronavirus disease 2019 (COVID-19), if and when a vaccine is developed—despite the fact that these populations are more likely than White individuals to become infected, experience more severe disease, and die of COVID-19. Being less likely to have health insurance or a regular source of health care and less likely to afford out-of-pocket costs for vaccines could pose barriers to accessing a COVID-19 vaccine.

The shingles vaccination rate among those with family incomes below the federal poverty level ($12 760 for 1 person, $26 200 for a family of 4) was only about half that of those with family incomes of 200% or greater than the poverty level (20.4% vs 38.4%). The authors found a similar divide among those with more than a high school education (39.9%) vs those with less than a high school diploma (21.2%).

There also was considerable geographic variation in the percentage of adults aged 60 years or older who ever had a shingles vaccination, ranging from 26.3% in the East South Central region (Alabama, Kentucky, Mississippi, and Tennessee) to 42.8% in the West North Central region (Iowa, Kansas, Missouri, Nebraska, North Dakota, and South Dakota), respectively.

“This report's findings are consistent with previous research regarding disparities in shingles vaccination by demographic and geographic characteristics,” the authors write.

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