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 studyexternal icon 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 communities that have historically had lower rates of flu vaccination. CDC recommends flu vaccination in 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 (2009-2010 through 2018-2019) *

 

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 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 for 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 (2009-2010 through 2018-2019)*

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. per 100,000 to 1.4 per 100,000.

Figure 3. Age-adjusted Flu-related In-Hospital Death by Race/Ethnicity (2009-2010 through 2018-2019)*

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)
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

*Age-adjusted rates 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 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.

* These estimates and the methodologies used to calculate them are published in JAMA Network Openexternal icon 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 studyexternal icon 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 vaccine uptake during the 2019-2020 flu season confirmed disparities in vaccine uptake, particularly among adults.

Among adults (18 years and older), while the overall coverage estimate was 48% during the 2019-2020 flu season, flu vaccination coverage was:

  • 38% among Hispanic or Latino people
  • 41% among non-Hispanic Black people
  • 42% among American Indian or Alaska Native people
  • 52% among Asian people
  • And 53% among non-Hispanic White people

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.
  • 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.