Flu Disparities Among Racial and Ethnic Minority Groups

Illustration of people of different ethic backgrounds

People from racial and ethnic minority groups experience higher rates of severe influenza (flu) illness. A CDC study examined differences in rates of flu-related hospitalization, intensive care unit (ICU) admission, and in-hospital death by race and ethnicity during 10 flu seasons (2009–2010 through 2018–2019).

This analysis showed disparities in hospitalization rates, intensive care unit admission rates, and in-hospital death rates. These disparities were even larger among children. To help combat these disparities, CDC is working to increase vaccination rates among racial and ethnic minority groups, which have historically had lower rates of flu vaccination. CDC recommends flu vaccination for everyone 6 months of age or older.

Overall Age-Adjusted Hospitalization Rates

  • Non-Hispanic Black people had the highest flu-related hospitalization rate (69 per 100,000)
  • Non-Hispanic American Indian or Alaska Native people had the second highest flu-related hospitalization rate (49 per 100,000)
  • Hispanic or Latino people had the third highest flu-related hospitalization rate (45 per 100,000)
  • Non-Hispanic White people had a lower flu-related hospitalization rate (38 per 100,000) compared with these three groups
  • Non-Hispanic Asian people had the lowest flu-related hospitalization rate (32 per 100,000)

Figure 1. Age-adjusted Flu-related Hospitalization by Race/Ethnicity (20092010 season through 20182019 season) *

 

Overall age-adjusted rates of hospitalization by race/ethnicity

*Rates are age-adjusted to account for differences in age distributions within race/ethnicity strata in the FluSurv-NET catchment area. 

Overall Age-Adjusted Intensive Care Unit Admission Rates

  • Non-Hispanic Black people had the highest flu-related ICU admission rate (12 per 100,000)
  • Non-Hispanic American Indian or Alaska Native people had the second highest flu-related ICU admission rate (9 per 100,000)
  • Hispanic or Latino people and non-Hispanic White people had the third highest flu-related ICU admission rate (7 per 100,000 each)
  • Non-Hispanic Asian people had the lowest flu-related ICU admission rate (6 per 100,000)

Figure 2. Age-adjusted Flu-related ICU Admission by Race/Ethnicity (20092010 season through 20182019 season)*

Overall age-adjusted rates of intensive care unit admission by race/ethnicity

*Rates are age-adjusted to account for differences in age distributions within race/ethnicity strata in the FluSurv-NET catchment area. 

Overall Age-Adjusted In-Hospital Death Rates

  • Age-adjusted in-hospital death rates ranged from 1.1 to 1.4 per 100,000.

Figure 3. Age-adjusted Flu-related In-Hospital Death by Race/Ethnicity (20092010 season through 20182019 season)*

Overall age-adjusted rates of in-hospital death by race/ethnicity

*Rates are age-adjusted to account for differences in age distributions within race/ethnicity strata in the FluSurv-NET catchment area. 

Table. Age-adjusted rate ratios* of flu-related hospitalization, ICU admission, and in-hospital death by race/ethnicity (2009-10 through 2018-19 seasons)
Rate ratios compared to Non-Hispanic White people Non-Hispanic American Indian or Alaska Native Non-Hispanic Asian or Pacific Islander Non-Hispanic Black Hispanic or Latino
Hospitalization 1.3x 0.8x 1.8x 1.2x
ICU admission 1.4x 0.9x 1.7x 1.1x
In-hospital death 0.9x 1.0x 1.1x 0.9x

*Ratio of age-adjusted rates for each race/ethnicity are compared against age-adjusted rate for non-Hispanic White persons

Flu Disparities Among Children

  • Disparities in severe flu outcomes were greatest in the youngest age groups (0–17), with hospitalization, ICU, and in-hospital mortality rates 1.3–4.4 times higher among racial and ethnic minorities aged 0–4 years compared with non-Hispanic White children.
    • Among non-Hispanic American Indian or Alaska Native children, rates of severe flu were 3.0–3.5 times higher.
    • Among non-Hispanic Black children, rates were 2.2–3.4 times higher.
    • Among Hispanic or Latino children, rates were 1.9–3.0 times higher.
    • Among non-Hispanic Asian or Pacific Islander children, rates were 1.3–4.4 times higher.


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* These estimates and the methodologies used to calculate them are published in JAMA Network Open and information about the Influenza Hospitalization Surveillance Network (FluSurv-NET) is also available.

Other Data

  • A CDC study published in 2016 showed that during the 2010–11 and 2011–12 flu seasons, non-Hispanic Black persons in every age group and Hispanic or Latino persons five years and older were more likely to be hospitalized with flu than non-Hispanic White persons. This study also showed that people living in high-poverty areas were at higher risk for severe outcomes from flu, suggesting that socioeconomic status may be a factor contributing to higher flu-related hospitalization rates among these groups.
  • A 2011 study found disparities in exposure risk, incidence of complications, and access to care during the 2009 influenza pandemic. Generally, a pandemic flu outbreak in the U.S. may be more likely to impact socially disadvantaged groups, including racial and ethnic minorities, disproportionately.
  • Because people of color may be at higher risk for getting flu or developing serious illness, resulting in hospitalization, flu vaccination is especially important for people in these communities. CDC recommends that everyone 6 months and older get a seasonal flu vaccine each year, ideally by the end of October. More information is available about when to get a flu vaccine.

Flu Vaccination Rates Lag Among Racial and Ethnic Minority Groups

While flu vaccination is the best way to prevent flu and its potentially serious complications, flu vaccination rates among people in racial and ethnic minority groups are lower than vaccination rates among non-Hispanic White people.

CDC’s new report summarizing flu vaccination uptake during the 2020–2021 flu season showed disparities in vaccine uptake among adults and children.

U.S. Flu Vaccination in Adults by Race and Ethnicity

Among adults (18 years and older), while the overall coverage estimate was 50.2% during the 2020–2021 flu season, flu vaccination coverage was:

  • 40.4% among non-Hispanic Black adults
  • 38.6% among Hispanic or Latino adults
  • 41.5% among American Indian or Alaska Native adults
  • 54.5% among Asian adults
  • And 55.5% among non-Hispanic White adults

Significant, longstanding disparities in flu vaccination coverage between certain racial and ethnic minority groups continued and, in some cases, worsened among adults during 2020–2021 compared to the prior season.

  • The difference in vaccination coverage between White adults and Black adults increased from 11.6 percentage points during the 2019–2020 season to 15.1 percentage points during the 2020–2021 season.
  • There continues to be a large difference in vaccination coverage between White adults and Hispanic adults (about 17 percentage points), but there was no statistically significant change in this disparity during the 2020–2021 season compared with the prior season.
  • Flu vaccination coverage for Black adults, Hispanic adults, and adults from other non-Hispanic racial and ethnic groups during the 2020–2021 season did not show statistically significant changes compared with the 2019–2020 season, while White adults had an increase in coverage.
U.S. Flu Vaccination Coverage in Children 6 months - 17 Years by Race and Ethnicity

Among children (6 months–17 years), while the overall coverage estimate was 58.6% during the 2020–2021 flu season, flu vaccination coverage was:

  • 49.1% among non-Hispanic Black children
  • 58.8% among Hispanic or Latino children
  • 48.3% among American Indian or Alaska Native children
  • 69.2% among Asian children
  • And 60.4% among non-Hispanic White children

Flu vaccination coverage in children decreased in all racial and ethnic groups during 2020–2021 compared with the prior season, and disparities in vaccination coverage increased among certain racial and ethnic minority groups.

  • The difference in vaccination coverage between White children and Black children increased from 5.2 percentage points during the 2019–2020 season to 11.3 percentage points during the 2020–2021 season.
  • And during the 2019–2020 season, Hispanic children had higher coverage than White children by 2.4 percentage points, but during the 2020–2021 season, this reversed, with Hispanic children having lower coverage by 1.6 percentage points.

What CDC is Doing to Address Flu Disparities Among Racial and Ethnic Minority Groups

  • Working to increase flu vaccination rates
    • Engaging with partners and developing customized outreach to racial and ethnic minority communities to increase flu vaccination rates this year and every year, including developing culturally specific messaging and linguistically tailored content to reach additional audiences.
    • Providing additional funding to state immunization programs to plan and implement flu vaccination programs for the 2021-2022 flu season, with a focus on priority groups, including non-Hispanic Black and Hispanic or Latino populations.
  • Collecting data on flu disparities
    • Collecting data to better understand how racial and ethnic minorities are disproportionately impacted by flu-related hospitalization.
    • Over the course of the 2021–2022 season, CDC will share some preliminary, within-season, weekly flu vaccination data and coverage estimates using existing and new data sources through the Weekly National Flu Vaccination Dashboard. The dashboard will be updated weekly or monthly, depending on the data source, starting October 7, 2021.
  • Creating programs that increase vaccine access and uptake
    • In 2020, CDC launched a new grant program, Partnering for Vaccine Equity. This program aims to reduce the disparities in vaccine access and uptake experienced by racial and ethnic minority groups by supporting a wide variety of partners working on increasing vaccine confidence in, and access to, flu and COVID-19 vaccines through community-based outreach and education.
    • A special campaign is ongoing, conducted in collaboration with the American Medical Association (AMA) and the Ad Council to inform the general population, with a focus on non-Hispanic Black and Hispanic or Latino audiences, about the importance of flu vaccination.
    • Additionally, funding made available because of the ongoing COVID-19 pandemic has established new infrastructure in state and local health departments that will enable them to more effectively promote flu vaccination, including for communities of color, this flu season.