New Haven, CT—Pharmacists working in lower socioeconomic areas should put extra effort in promoting influenza vaccines, according to a new study finding that those who live in high poverty census tracts are at higher risk for severe influenza outcomes.

“Persons in poorer neighborhoods should be a focus for enhanced influenza vaccination outreach and early use of antiviral treatment,” notes a report published recently in the Morbidity & Mortality Weekly Report.

As part of the study led by Yale School of Public Health researchers and involving the national Centers for Disease Control and Prevention in Atlanta, a collaborative initiative among 14 states examined the association between census tract-level poverty and incidence of influenza-related hospitalization. Results indicate increasing rates of influenza-related hospitalization with increasing census tract poverty over two influenza seasons, among all 14 sites, all age and racial/ethnic groups, and for more severe outcomes of hospitalization, such as intensive care, respiratory support, and death.

“Possible contributing factors are lower vaccination rates in residents of poorer census tracts, poverty-related crowding with higher rates of influenza transmission, and higher prevalence of medical conditions predisposing persons to influenza complications in poorer areas,” study authors write. “However, differences in vaccination rates cannot fully explain all the age-specific differences by census tract poverty observed: only hospitalized influenza patients aged ≥65 years had a large enough difference in vaccination rates to fully explain the findings.”

Whatever the cause of poverty-associated disparities in influenza-related hospitalizations, according to the study, “there is a need to increase influenza vaccination levels in higher poverty neighborhoods and to more fully implement recommendations on the use of antivirals in the outpatient setting. This will require enhanced efforts by public health agencies and healthcare providers to address missed opportunities for vaccination and system barriers, as well as a better understanding of personal barriers to influenza vaccination in these neighborhoods. In addition, it will require evaluation of use of antivirals and efforts to improve them.”

The report also emphasizes the importance of using socioeconomic status measures as variables for surveillance data analysis.

“It is important from an influenza control perspective that local vaccination efforts be emphasized in demographic groups found to have a higher incidence of more severe and costly complications of influenza, including hospitalization, intensive care and mechanical ventilation. Based on the consistency of the findings in this study across FluSurv-NET sites, persons who live in high-poverty census tracts are one such demographic group,” the researchers explain. “Enhanced influenza outreach to improve influenza vaccination coverage for persons living in poorer neighborhoods and efforts to increase use of antivirals by clinicians serving these neighborhoods could reduce poverty-related disparities in severe influenza outcomes.”

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