Disparities in Season Flu Vaccine uptake among Spanish and English-Speaking Hispanic Americans: A cross-sectional analysis of Behavioral Risk Factor Surveillance Systems (BRFSS) from 2017-2020

Introduction: Research has shown that vaccination for Seasonal Influenza (flu) is associated with a nearly ⅓ reduction in flu-related mortality and a ¼ reduction in likelihood of ICU admission.¹ From 2009-2019, Hispanic residents of the United States had the third highest rate of flu-related hospitalization with more severe outcomes including intensive care and mortality than non-Hispanic Whites.²  Thus, the purpose of this study is to analyze Behavioral Risk Factor Surveillance System (BRFSS) data in order to compare rates between Spanish- and English- speaking Hispanics aged 18-64 and among those 65 and older from2017-2020 with a secondary objective to investigate trends among age groups by sex.

Methods: For this cross-sectional study we extracted data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2017-2020. The BRFSS uses raking weights to produce population estimates that adjust for survey non-coverage, non-response, and the probability of being sampled given geographic location, age, race, and sex.⁹ Respondents were included if they identified as being Hispanic and responding to a question regarding flu vaccination (either via shot or nasal spray). Other variables extracted included the language of the survey used (to identify Spanish and English speaking participants), age (18-64 and 65+), and sex. We then estimated the prevalence of flu vaccination among easy BRFSS cycle overall and among each sub-group (Language, sex, and age-group) and used X² tests of independence to determine associations among groupings.

Results: Trends of the data showed that flu vaccine uptake among all Hispanics was lowest in 2018 (25.29%) while 2020 was the highest (34.83%). Each year, the 65 and older age grouping had higher rates of flu vaccine uptake compared to the 18-64 age group. Significant differences among English and Spanish-speaking groups occurred each year, most often occurring among the 18-64+ group of both sexes. Hispanic US adults ages 65 and over had the highest percentage of flu shots received in 2017 (57.75%) while 2018 had the lowest (50.11%). Spanish-speaking men, age 18-64, had the lowest uptake of flu vaccination throughout the time span.

Conclusion: From 2018 through 2020 there was a statistically significant difference in uptake of English-speaking women when compared to Spanish-speaking women ages 18-64. Predominantly English speaking women aged 18-64 had higher vaccination rates in 2019 and 2020 while Spanish-speaking women had higher rates in 2017. Pearson et al. found that Spanish-speaking Hispanics, aged 65 or older, were significantly less likely to have received the influenza vaccine compared to English-speaking Hispanics from 2005-2007.3 Our study reveals that this trend changed in 2018 when more Spanish-speaking women received vaccination than English-speaking women aged 65+. Spanish-speaking men aged 18-64 were also less likely to receive vaccination than Spanish-speaking women aged 18-64 across the board when comparing statistically significant data.