Relationship between local family physician supply and influenza vaccination after controlling for individual and neighborhood effects

• Published in: American journal of infection control 2014-05, Vol.42 (5), p.500-505
• Main Authors: Gai, Yunwei, PhD, Gu, Ning Yan, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Area Resource Files; Behavioral Risk Factor Surveillance System; Biological and medical sciences; Confidence intervals; Contextual and neighborhood characteristics; Effects; Employment; Epidemiology. Vaccinations; Family physician shortage; Female; General aspects; Health care disparity; Human viral diseases; Humans; Immunization; Infection Control; Infectious Disease; Infectious diseases; Influenza; Influenza Vaccines - administration & dosage; Influenza, Human - prevention & control; Male; Medical sciences; Middle Aged; Multivariate analysis; Neighborhoods; Physicians; Physicians, Family - statistics & numerical data; Vaccination - utilization; Viral diseases; Viral diseases of the respiratory system and ent viral diseases; Young Adult
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2013.12.006

Background Family physicians (FPs) play an important role in influenza vaccination. We investigated how local FP supply is associated with influenza vaccination, controlling for both individual-level and county-level characteristics. Methods The 2008-2010 individual-level data from the Behavioral Risk Factor Surveillance System were merged with county-level data from the Area Resource File (n = 985,157). Multivariate logistic analyses were performed to predict influenza vaccination using the number of FPs per 1000 population as the key predictor, adjusting for individual-level demographic, socioeconomic, and health information, as well as county-level racial composition and income level. Additional analyses were performed across racial/ethnic and employment status categories. Results Increasing local FP supply was associated with higher odds (adjusted odds ratio [aOR], 1.58; 95% confidence interval [CI], 1.49-1.67) and varied across racial/ethnic groups (Hispanic: aOR, 2.05, 95% CI, 1.55-2.72; non-Hispanic white: aOR, 1.57, 95% CI, 1.48-1.66; non-Hispanic black: aOR, 1.49, 95% CI, 1.18-1.89), employment status categories, and county types. Conclusions FP supply was significantly associated with influenza vaccination. The association was greatest among those who were Hispanic, residing in a rural area, or out of work. Our findings lend support to initiatives aimed at increasing the FP supply, particularly among disadvantaged populations.