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Dedra Buchwald, MD; John Sheffield, MD; Richard Furman, MA; Suzanne Hartman; Matt Dudden, MS; Spero Manson, PhD

Arch Intern Med. 2000;160:1443-1448.

Background  More than 2 million Native Americans (ie, Native Americans and Native Alaskans) live in the United States; 60% reside in cities. This population, especially its elders, is especially susceptible to respiratory diseases; yet, adherence to guidelines for influenza and pneunococcal immunizations is unknown.

Objectives  To evaluate how frequently older and high-risk adults received vaccinations for influenza and pneumoncoccal infection and to identify patient 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 appropriate age threshold (50 years) and standard criteria (65 years). Univariate analyses examined demographic and clinical information by vaccination status. Logistic regressions identified factors associated with adherence to immunization guidelines.

Results  Among patients aged 50 years and older with any indication according to published recommendations, rates were low for influenza (31%) and pneumococcal (21%) immunizations. Likewise, few subjects at least 65 years of age had been immunized appropriately against influenza (38%) or pneumococcus (32%). Younger age and alcohol use were significantly associated with less frequent immunization; Medicare insurance, depression, and more health problems and taking more medications predicted significantly higher immunization rates. Aged 65 years or older and having cardiovascular disease or diabetes mellitus were specific indications significantly correlated with receipt of influenza and pneumococcal vaccine.

Conclusions  Regardless of age or risk, inadequate vaccination rates were observed in elderly Native Americans. Our findings suggest the need to identify obstacles to immunization and to conduct prospective and elderly intervention studies in Native American populations.

From the Departments of Medicine, University of Washington, Seattle, (Drs Buchwald and Sheffield, Mr Furman, and Ms Hartman); and the Department of Psychiatry, University of Colorado Health Sciences Center, Denver (Mr Dudden and Dr Manson).

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