Influenza and pneumococcal vaccination among Native American elders in a primary care practice

Background: More than 2 million Native Americans tie, Native Americans and Native Alaskans) live in the United States; 60% reside in cities. This popu lation, especially its elders, is especially susceptible to respiratory dis eases; yet, adherence to guidelines for influenza and pneunococcal immuniza tions is unknown. Objectives: To evaluate how frequently older acid highrisk adults received vaccinations for influenza and pneumoncoccal infection and to identify pati ent characteristics associated with adherence to published recommendations. Methods: Retrospective medical record review of 550 Native American elders seen in an urban primary care practice defined using a culturally appropria te age threshold (greater than or equal to 50 years) and standard criteria (greater than or equal to 65 years). Univariate analyses examined demograph ic and clinical information by vaccination status. Logistic regressions ide ntified factors associated with adherence to immunization guidelines. Results: Among patients aged 50 years and older with any indication accordi ng to published recommendations, rates were low for influenza (31%) and pne umococcal (21%) immunizations. Likewise, few subjects at least 65 years of age had been immunized appropriately against influenza (38%) or pneumococcu s (32%). Younger age and alcohol use were significantly associated with les s frequent immunization; Medicare insurance, depression, and more health pr oblems and taking more medications predicted significantly higher immunizat ion rates. Aged 65 years or older and having cardiovascular disease or diab etes mellitus were specific indications significantly correlated with recei pt of influenza and pneumococcal vaccine. Conclusions: Regardless of age or risk, inadequate vaccination rates were o bserved in elderly Native Americans. Our findings suggest the need to ident ify obstacles to immunization and to conduct prospective and elderly interv ention studies in Native American populations.