The mediating effects of barriers to vaccination on the relationship between race/ethnicity and influenza vaccination status in a rural Southeastern Louisiana medical center.

Introduction: Persistent disparities in influenza vaccination rates exist between racial/ethnic minorities and Whites. The mechanisms that define this relationship are under-researched. Methods: Surveys assessing barriers to vaccination were administered to outpatients in a rural medical center in Southeastern Louisiana. Survey responses were matched to patient medical records. Likert-style statements were used to measure barriers to vaccination. A mediation analysis assessing the relationship between race and influenza vaccination mediated by vaccination barriers was conducted. Results: The self-reported influenza vaccination rate in those surveyed was 40.4%. Whites (45.5%) were more likely than racial/ethnic minorities (36.3%) to report receipt of an influenza vaccination (p = 0.02). Racial/ethnic minorities reported significantly higher vaccination barrier scores (p < 0.01). The relationship between race/ethnicity and vaccination was mediated by vaccination barriers, when controlling for provider recommendation and having at least one comorbid medical condition (natural indirect effect [NIE] p-value = 0.02, proportion mediated = 0.71). Conclusions: Barriers to vaccination mediates the relationship between race/ethnicity and vaccination status. Providers should focus on minimizing fears that the vaccine will cause illness and emphasize that the vaccine is safe and effective at preventing severe influenza-associated illness. Additional efforts should be made to improve accessibility of the influenza vaccine, including addressing costs of vaccination and expanding the number and types of settings where the vaccine is offered.

Assessing influenza vaccination coverage and predictors in persons living with HIV/AIDS in Louisiana, June 2002-June 2013.

Background: Despite the burden of disease and increased risk of influenza-associated morbidity and mortality among PLWHA, influenza vaccination has been understudied in this population. Methods: We built an 11-year cohort of HIV-infected adults from medical records of PLWHA seeking care within the Louisiana State University medical system from June 2002-June 2013. Influenza vaccination uptake among PLWHA was calculated overall and for each medical facility for each influenza season. Linear regression was used to assess influenza vaccination uptake over time, both overall and by facility. Data were restricted to the final influenza season (2012-13) to assess predictors of PLWHA vaccination. Individuals were nested within medical facilities in order to assess the amount of variability in influenza vaccination rates across medical facilities. Results: Influenza vaccination uptake among PLWHA increased over the study period (p < 0.01). The overall proportion of PLWHA vaccinated during the 2012-13 influenza season was 33.7%. 37.9% of the variability in the model occurred at the facility-level. Conclusions: Although there was an increase in influenza vaccination within the PLWHA cohort over the course of the study, vaccination rates remained low overall. Special efforts must be made to increase vaccination uptake among PLWHA, with particular focus on those within the population who are likely to be at highest risk. The substantial variability at the facility-level indicates that there are unmeasured facility-level factors that contribute significantly to PLWHA vaccination.

Smoking Relapse and Type 2 Diabetes Mellitus-Related Emergency Department Visits Among Senior Patients with Diabetes.

INTRODUCTION: Quitting smoking has been proven to benefit smokers with diabetes. However, among older patients with diabetes, the evidence regarding an association between smoking status and the risk of type 2 diabetes mellitus-related emergency department (ED) visits has not been well investigated. METHODS: A retrospective cohort study was performed by using the Louisiana State University Health Care Services Division electronic health records from 2009 to 2011. Patients aged 65 years or older with type 2 diabetes and smoking status recorded at least twice in 2010 were selected. Selected patients with diabetes were classified into nonsmokers, former smokers, continuing smokers, and relapsed smokers. Cox proportional hazards regression models were used to estimate the adjusted hazard ratio (aHR) of 1-year type 2 diabetes-related ED visits for each group compared with nonsmokers. RESULTS: There were 174 (8.2%) continuing smokers and 77 (3.6%) relapsed smokers in 2,114 patients with diabetes who were studied. Rates of type 2 diabetes-related ED visits were highest in relapsed smokers (28.6%). Compared with nonsmokers, relapsed smokers had a significantly higher risk of type 2 diabetes-related ED visits (aHR = 1.62; 95% confidence interval [CI], 1.04-2.50). After stratifying by sex, a significantly increased risk of type 2 diabetes-related ED visits was shown only in male relapsed smokers (aHR = 2.05; 95% CI, 1.13-3.71) and female continuing smokers (aHR = 1.65; 95% CI, 1.10-2.47) compared with nonsmokers. CONCLUSION: Older men with diabetes who were relapsed smokers had a higher risk of type 2 diabetes-related ED visits. Future research and clinical practice should focus on these patients and create more effective interventions for smoking cessation and diabetes management.