Vaccines Elude Minorities

Lower Rates for African American Diabetics Blamed on Both Patients and Doctors

From the WebMD Archives

Feb. 10, 2003 -- Each year, as many as 80,000 Americans die from the flu and pneumonia, and those with diabetes are especially vulnerable. But even with equal access to healthcare providers and medical insurance, a new study shows that blacks and Hispanics are nearly half as likely as other diabetics to receive vaccines to protect them from these conditions.

This finding, in the February issue of the American Journal of Public Health, is the latest of several hundred studies documenting that minorities typically receive inferior medical treatment compared with whites. Though many of those previous findings have pointed to unequal access to healthcare and social economic status, this time the study authors pass the blame around.

"The problem is the result of both the patient and the physician," says study researcher Leonard E. Egede, MD, of the Medical University of South Carolina. "Minority patients often don't want the vaccines because they are more likely to mistrust their doctors or have been misinformed on their benefits. But physicians may not be offering vaccinations to their minority patients as often as they do for white patients. And even when they do and the patients refuse them, they don't make as much effort to convince them to get the shots."

Though federal statistics indicate that racial disparities continue for all types of immunizations and among all ages, the difference is most apparent when it comes to flu and pneumonia vaccines. Though only 3% fewer black children are vaccinated against measles, mumps, and rubella than white children, nearly two in three elderly white Americans get an annual flu shot, compared with only 48% of blacks and 56% of Hispanics.

Vaccines against the flu and pneumonia are especially important to those with diabetes, especially since they have higher death rates during epidemics than people without diabetes. About one in three people who die from pneumonia are diabetics, as are about 12% of those who die from complications of the flu, according to the National Coalition for Adult Immunization (NCAI), a federally funded program to boost immunization rates.

"Diabetics have a much higher death rate from any type of infection, but are especially at risk for flu and pneumonia," Egede tells WebMD. "The whole idea is to use vaccines as a way of protecting people against the complications of these disease -- especially those people at the greatest risk. But that isn't happening with certain minority populations."

African Americans get diabetes 1.6 times as often as white Americans, and Hispanics face twice the risk as whites. However, Egede found after adjusting for factors such as access to healthcare, insurance, and social economic status, both Hispanics and white Americans are being vaccinated against the flu and pneumonia nearly twice as often as African Americans. His findings are based on data of 1,906 Americans diagnosed with diabetes who responded to a federal survey.

But this isn't the first study to show the black-and-white realities of how race and ethnicity play into the quality of healthcare. There have been more than 800 studies documenting that minorities do not get the same type of care as whites, says Peter Muennig, MD, PhD, of the City University of New York Medical School, where much of this research is conducted.

"Patient mistrust of physicians is certainly part of the equation, but probably a small part," he tells WebMD. "A lot of the research suggests that even with similar access to medical care or health insurance, minority groups are often treated at clinics that may be understaffed. Because of this, there may not be anyone to check medical records or set up a protocol for vaccinations. This is why it's becoming increasingly important for minority patients to take the lead to demand care and educate themselves on the benefits of getting flu shots."

In fact, another researcher tells WebMD that self-motivation may explain why whites are more likely to get vaccines. Paul Hebert, PhD, of Mt. Sinai School of Medicine just completed a study, which hasn't yet been published, examining the rates of flu and pneumonia vaccines among white and minority Medicare patients.

"I had a similar finding, indicating that African-Americans were about half as likely to receive these vaccines compared to whites or Hispanics," he tells WebMD. "While I did find there was some more resistance against the vaccines among African-Americans than in whites or Hispanics, that doesn't explain the whole story. When I looked into why people went to the doctors during flu vaccination season, I found that whites were three to four times more likely to go to their doctors specifically to get a flu shot. When Africans Americans got the vaccines, it typically was an adjunct treatment for another visit.

"It was the self-motivated behavior on the part of white patients that described almost all the racial differences in who did and didn't receive the vaccinations."

Show Sources

SOURCES: American Journal of Public Health, February 2003 • National Coalition for Adult Immunization • National Academies' Institute of Medicine report, "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," March 20, 2002 • Leonard E. Egede, MD, assistant professor of medicine, Medical University of South Carolina, Charleston • Peter Muennig, MD, PhD, assistant professor, department of Community Health and Social Medicine, City University of New York Medical School • Paul Hebert, PhD, assistant professor of medicine, Mt. Sinai School of Medicine, New York.
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