Many Spanish-speaking Hispanics go un-immunized
NEW YORK (Reuters Health) - Older Hispanics who prefer to speak Spanish or who live in communities where little English is spoken may be more likely to miss their pneumonia or seasonal flu vaccinations, suggests a large new study.
The consequences can be severe for seniors, a population known to be at high risk of serious complications from both pneumonia and influenza. Experts recommend that seniors get the seasonal flu vaccine every year and the pneumonia vaccine once after the age of 65, with a booster 5 years later if they are at particularly high risk.
"Immunizations are so important for seniors. They save lives," Amelia Haviland of the RAND Corp., in Santa Monica, California, told Reuters Health. "And any group that has a lower take-up rate of immunizations poses a public health risk, particularly for their communities, but also for everyone."
Hispanic seniors are known to be more likely than their white peers to miss immunizations. Their low vaccination and high infection rates during the 2009 H1N1 flu epidemic, and the more recent whooping cough outbreak in California, are cases in point.
But it's been several years since estimates of immunization rates have been made -- and no prior research has looked into differences in rates among different subgroups of Hispanic seniors, according to Haviland.
"They're a very diverse group, so this information could be really useful for targeting efforts," she added.
In the new study, Haviland and her colleagues looked at data from a Medicare survey of nearly 250,000 Hispanic and non-Hispanic seniors (aged 65 or older) across the U.S.
They found that pneumonia immunization rates varied substantially among the groups -- from 74 percent among whites to 40 percent among Spanish-speaking Hispanics. Hispanics who preferred to speak English faired in the middle at 56 percent.
Rates of flu immunizations were also lower among Spanish- and English-speaking Hispanics -- 64 percent and 68 percent, respectively -- compared to 76 percent of whites, the researchers reported in the Archives of Internal Medicine.
For seniors on Medicare, the flu and pneumonia vaccines are free. This year in the U.S., popular drug store chains have been offering flu shots for about $30. The cost of a pneumonia vaccine can be twice that, or more -- but experts point out that the price is still much less than what it would cost to be hospitalized with severe complications of the infection.
But even after the researchers took factors such as income, health, and education into account, there were still differences between the groups, although not as large.
Further, disparities in flu shot rates appeared higher in "linguistically isolated" areas, where a large proportion of the residents have limited English skills, as well as in "new destination" communities, such as agricultural areas in the southeast that lack a historic Hispanic population.
"This suggests that when there is a long-standing community, they are able to build up better access and better resources for Hispanics in the area," said Haviland, noting that well-established communities may, for example, have greater opportunities to recruit Spanish-speaking doctors.
Newer communities may also lack continuity of care, or providers who care for their patients over a number of years and would know if a 68-year-old senior had received his or her pneumonia vaccine yet, she added.
"Policy makers, public health officials and health care providers need to work to raise the low immunization rates among Hispanic seniors," Haviland said, "in particular seniors who prefer Spanish, or live in Spanish-speaking or newly-formed communities."
However, the researchers also found that in regions with large "linguistically isolated" and "new destination" Hispanic communities, vaccination rates among whites suffered, too, although not to the same extent.
"While particular efforts are needed to bring up rates for Hispanics," Haviland said, "there are areas where greater attention is needed for everyone."
SOURCE: bit.ly/e9aQ01 Archives of Internal Medicine, online January 24, 2010.
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