Disparities in Influenza Vaccination Coverage and Associated Factors Among Adults with Cardiovascular Disease, United States, 2011–2020
ORIGINAL RESEARCH — Volume 19 — October 27, 2022
PEER REVIEWED
Figure 1.
State-specific trends in the prevalence of influenza vaccination among US adults with cardiovascular disease, Behavioral Risk Factor Surveillance System, 2011–2020. Linear and quadratic trends were calculated by using adjusted regression models with survey years modeled as orthogonal polynomials. Abbreviation: NA, not available.
| State by region | Prevalence | P for linear trend | P for quadratic trend | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | |||
| New England | ||||||||||||
| Connecticut | 39.8 | 33.1 | 40.4 | 53.6 | 49.4 | 52.3 | 47.7 | 29.6 | 54.0 | 50.5 | .002 | .13 |
| Maine | 42.7 | 46.9 | 44.1 | 37.1 | 47.6 | 47.8 | 37.3 | 28.6 | 34.4 | 47.5 | .25 | .01 |
| Massachusetts | 45.1 | 46.0 | 45.5 | 41.1 | 40.0 | 34.6 | 42.3 | 29.6 | 43.2 | 53.7 | .47 | <.001 |
| New Hampshire | 41.1 | 44.1 | 32.6 | 39.7 | 47.2 | 54.5 | 51.6 | 25.6 | 46.9 | 36.1 | .84 | .37 |
| Rhode Island | 37.9 | 46.7 | 42.6 | 48.0 | 36.6 | 41.8 | 47.3 | 30.9 | 38.1 | 60.0 | .09 | .30 |
| Vermont | 47.0 | 33.9 | 42.4 | 54.5 | 38.3 | 31.8 | 32.4 | 35.7 | 45.6 | 48.3 | .001 | .08 |
| Middle Atlantic | ||||||||||||
| New Jersey | 36.4 | 36.4 | 27.3 | 34.9 | 42.1 | 47.2 | 51.4 | 32.4 | NA | 48.3 | .04 | .88 |
| New York | 36.3 | 51.5 | 35.1 | 39.5 | 42.0 | 45.2 | 35.6 | 29.3 | 39.7 | 41.1 | .22 | .38 |
| Pennsylvania | 48.6 | 45.4 | 38.2 | 36.7 | 38.0 | 38.5 | 56.3 | 39.3 | 51.8 | 60.8 | .01 | .02 |
| East North Central | ||||||||||||
| Illinois | 36.0 | 30.5 | 47.0 | 42.6 | 39.3 | 43.3 | 30.4 | 31.7 | 51.5 | 33.3 | .91 | .04 |
| Indiana | 39.8 | 41.5 | 40.7 | 30.0 | 39.3 | 31.7 | 33.7 | 22.0 | 40.0 | 43.9 | .09 | <.001 |
| Michigan | 47.7 | 37.8 | 34.6 | 37.7 | 39.9 | 38.6 | 33.6 | 27.9 | 32.4 | 44.0 | .56 | .02 |
| Ohio | 46.3 | 34.8 | 37.5 | 30.9 | 35.6 | 39.1 | 42.6 | 33.5 | 38.5 | 47.3 | .26 | .001 |
| Wisconsin | 53.2 | 36.2 | 36.0 | 32.8 | 29.9 | 34.0 | 51.0 | 37.9 | 34.3 | 48.3 | .95 | <.001 |
| West North Central | ||||||||||||
| Iowa | 41.4 | 56.1 | 40.2 | 48.2 | 40.6 | 55.6 | 43.3 | 36.2 | 49.1 | 44.5 | <.001 | .97 |
| Kansas | 42.2 | 42.9 | 43.7 | 41.4 | 41.6 | 37.2 | 35.0 | 34.0 | 46.5 | 47.3 | .05 | <.001 |
| Minnesota | 43.9 | 54.0 | 45.0 | 42.3 | 41.3 | 46.9 | 47.6 | 34.4 | 44.4 | 51.1 | .29 | .003 |
| Missouri | 37.7 | 35.7 | 46.4 | 37.6 | 59.3 | 48.7 | 35.1 | 33.7 | 43.2 | 42.8 | .28 | .23 |
| Nebraska | 41.5 | 42.5 | 43.1 | 44.6 | 49.7 | 52.3 | 50.2 | 38.1 | 53.0 | 59.4 | .02 | .08 |
| North Dakota | 62.1 | 41.0 | 53.4 | 35.5 | 50.6 | 39.8 | 53.8 | 37.5 | 41.6 | 33.2 | .55 | .56 |
| South Dakota | 57.2 | 51.2 | 52.5 | 48.6 | 56.8 | 51.4 | 51.3 | 25.7 | 51.6 | 64.0 | .001 | .19 |
| South Atlantic | ||||||||||||
| Delaware | 43.2 | 38.1 | 54.7 | 42.1 | 58.6 | 41.7 | 41.5 | 33.1 | 51.9 | 52.3 | .72 | .14 |
| District of Columbia | 39.8 | 37.8 | 38.1 | 24.5 | 27.7 | 43.8 | 33.9 | 53.1 | 44.7 | 56.2 | .10 | <.001 |
| Florida | 32.7 | 34.7 | 29.6 | 28.6 | 27.6 | 36.4 | 34.4 | 28.0 | 33.2 | 49.6 | .44 | .04 |
| Georgia | 29.3 | 34.6 | 37.8 | 38.2 | 32.5 | 36.0 | 41.7 | 26.5 | 35.7 | 40.6 | .61 | .81 |
| Maryland | 41.2 | 36.6 | 42.8 | 48.8 | 38.2 | 42.2 | 50.5 | 39.3 | 45.5 | 46.7 | .27 | .009 |
| North Carolina | 42.8 | 42.6 | 48.6 | 39.9 | 37.2 | 40.3 | 42.8 | 44.0 | 47.7 | 40.5 | .24 | .049 |
| South Carolina | 41.8 | 40.0 | 47.7 | 33.7 | 40.0 | 34.2 | 37.7 | 33.7 | 42.3 | 34.7 | .003 | .27 |
| Virginia | 41.1 | 30.9 | 40.5 | 37.7 | 51.9 | 37.1 | 38.1 | 32.1 | 46.8 | 51.8 | .64 | .02 |
| West Virginia | 50.1 | 42.1 | 45.1 | 50.8 | 42.9 | 44.3 | 49.2 | 40.1 | 38.0 | 45.9 | <.001 | .38 |
| East South Central | ||||||||||||
| Alabama | 44.7 | 40.1 | 45.0 | 37.3 | 41.0 | 34.8 | 42.1 | 41.4 | 39.6 | 36.1 | .84 | .03 |
| Kentucky | 36.7 | 36.8 | 42.4 | 45.6 | 41.7 | 31.3 | 36.2 | 38.5 | 36.8 | 50.3 | .80 | .10 |
| Mississippi | 43.8 | 38.4 | 38.5 | 36.0 | 41.9 | 36.1 | 36.2 | 33.9 | 43.9 | 45.7 | .46 | .02 |
| Tennessee | 37.6 | 46.8 | 50.9 | 40.9 | 40.2 | 36.7 | 26.5 | 25.0 | 32.7 | 34.2 | .10 | .02 |
| West South Central | ||||||||||||
| Arkansas | 34.9 | 35.3 | 31.1 | 34.5 | 37.5 | 48.2 | 32.7 | 24.4 | 32.0 | 52.5 | .86 | .06 |
| Louisiana | 44.6 | 45.0 | 38.0 | 45.6 | 45.6 | 39.0 | 31.8 | 31.2 | 36.3 | 39.3 | <.001 | .20 |
| Oklahoma | 43.1 | 40.3 | 43.7 | 53.2 | 41.3 | 38.6 | 46.0 | 34.4 | 40.1 | 52.9 | .85 | .72 |
| Texas | 33.4 | 33.5 | 36.6 | 39.6 | 46.3 | 31.9 | 27.4 | 25.6 | 34.1 | 42.4 | .48 | .02 |
| Mountain | ||||||||||||
| Arizona | 36.5 | 38.2 | 41.2 | 36.8 | 31.6 | 35.7 | 40.5 | 24.7 | 38.4 | 39.5 | .92 | .06 |
| Colorado | 44.7 | 39.4 | 44.9 | 53.0 | 47.5 | 44.9 | 51.0 | 39.7 | 49.1 | 52.8 | .95 | .23 |
| Idaho | 33.9 | 37.1 | 34.9 | 36.0 | 36.3 | 39.9 | 27.9 | 27.1 | 34.5 | 46.7 | .16 | .15 |
| Montana | 32.1 | 34.4 | 41.5 | 34.4 | 29.8 | 39.5 | 30.7 | 28.9 | 35.0 | 42.9 | .71 | .55 |
| Nevada | 29.2 | 27.6 | 31.7 | 29.3 | 42.7 | 41.9 | 29.9 | 43.4 | 34.6 | 35.5 | .04 | .51 |
| New Mexico | 44.9 | 42.5 | 45.0 | 34.7 | 41.0 | 41.9 | 39.0 | 36.9 | 32.0 | 44.4 | .49 | .03 |
| Utah | 45.5 | 39.8 | 41.2 | 37.5 | 44.6 | 39.6 | 37.0 | 33.0 | 44.1 | 54.6 | .10 | <.001 |
| Wyoming | 38.7 | 31.2 | 31.6 | 30.8 | 48.8 | 38.4 | 40.5 | 24.3 | 48.5 | 33.6 | .76 | .098 |
| Pacific | ||||||||||||
| Alaska | 35.6 | 38.7 | 51.8 | 55.3 | 43.6 | 26.1 | 30.8 | 27.8 | 36.5 | 26.6 | .97 | .61 |
| California | 35.8 | 39.9 | 35.3 | 40.9 | 32.1 | 35.5 | 49.2 | 34.9 | 51.3 | 41.3 | .197 | .01 |
| Hawaii | 45.4 | 49.1 | 46.0 | 49.9 | 35.2 | 34.5 | 42.0 | 31.0 | 43.2 | 50.0 | .10 | <.001 |
| Oregon | 32.6 | 33.3 | 40.8 | 43.9 | 31.7 | 30.8 | 38.2 | 30.1 | 41.0 | 40.5 | .51 | .048 |
| Washington | 41.8 | 40.4 | 41.3 | 43.0 | 42.4 | 49.5 | 45.4 | 41.5 | 41.0 | 44.5 | .007 | .27 |
| US Islands | ||||||||||||
| Guam | 25.5 | 21.5 | 26.2 | 31.4 | 24.5 | 29.9 | 27.1 | 26.2 | 30.1 | 26.1 | .52 | .63 |
| Puerto Rico | 16.4 | 14.4 | 19.4 | 22.7 | 26.2 | 19.3 | 23.4 | 20.9 | 17.6 | 22.6 | .005 | .05 |
| Virgin Islands | NA | NA | NA | NA | NA | 18.9 | NA | NA | NA | NA | NA | NA |
Figure 2.
Common places for receiving an annual influenza vaccination among US adults with cardiovascular disease, Behavioral Risk Factor Surveillance System, 2011–2020. “Other health care facility” includes health department, another type of clinic or health center, and a community health center. Store includes supermarkets or drug stores. “Other place” includes senior or recreation center, some other kind of place, school, received outside US, and don’t know/not sure/refused.
| Place | 2011 | 2012 | 2015 | 2018 |
|---|---|---|---|---|
| Doctor’s office | 49.4 | 49.6 | 48.6 | 47.3 |
| Other health care facility | 12.2 | 11.2 | 9.1 | 9.4 |
| Hospital/emergency room | 8.9 | 8.5 | 7.9 | 7.4 |
| Store | 19.2 | 21.1 | 25 | 28.5 |
| Workplace | 5.2 | 4.6 | 4.4 | 3.8 |
| Other | 5.1 | 5.1 | 5.0 | 3.7 |
Figure 3. Results of multivariate regression models showing association between annual influenza vaccination and types of cardiovascular disease among US adults, Behavioral Risk Factor Surveillance System, January 2011–December 2020. Models were adjusted for reported sociodemographic characteristics, health care characteristics, and cardiovascular disease risk factors. Error bars indicate 95% CIs. Except for heart attack/myocardial infarction, odds are significant at P < .05 by 2-sided z test. Abbreviations: CHD, coronary heart disease; CVD, cardiovascular disease; MI, myocardial infarction.
| Cardiovascular disease | Adjusted odds ratio (95% CI) |
|---|---|
| Angina or coronary heart disease | |
| Yes | 1.18 (1.15–1.22) |
| No | 1 [Reference] |
| Heart attack or myocardial infarction | |
| Yes | 0.97 (0.94–1.00) |
| No | 1 [Reference] |
| Stroke | |
| Yes | 0.94 (0.91–0.97) |
| No | 1 [Reference] |
| No. of cardiovascular diseases | |
| ≥2 | 1.08 (1.05–1.11) |
| 1 | 1 [Reference] |
Appendix. Supplementary Figure. Influenza vaccination rates among US adults, by cardiovascular disease status, Behavioral Risk Factor Surveillance System, January 2011–December 2020.
| CVD status | Year | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | |
| No CVD, % | 34.2 | 32.9 | 35.5 | 35.5 | 37.5 | 35.4 | 37.0 | 30.0 | 39.4 | 42.7 |
| Yes CVD, % | 38.6 | 38.5 | 38.9 | 38.5 | 39.4 | 38.3 | 39.3 | 32.1 | 40.4 | 44.3 |
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