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Disparities in Influenza Vaccination Coverage and Associated Factors Among Adults with Cardiovascular Disease, United States, 2011–2020

ORIGINAL RESEARCH — Volume 19 — October 27, 2022

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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-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

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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.

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

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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.

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]

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Appendix. Supplementary Figure. Influenza vaccination rates among US adults, by cardiovascular disease status, Behavioral Risk Factor Surveillance System, January 2011–December 2020.

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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