Among the high-risk group, being uninsured was associated with the lower likelihood of being vaccinated. 29.5% of high-risk, uninsured adults were vaccinated, while 57.5% of high-risk, insured adults were vaccinated. 

Saint Louis University

This study, whose sample group consists of predominantly Black and/or Latino adults (aged 18-65), from low-income neighborhoods in New Haven, CT, focuses on identifying undervaccinated subgroups. 
- Among the high-risk respondents, those who were uninsured had relatively low flu vaccine uptake.
- Only 29.5% of the high-risk uninsured respondents were vaccinated. Vaccination uptake among high-risk respondents with health insurance was higher. 
- 59.0% of high-risk, insured, and never experienced medical mistreatment adults were vaccinated. 
- 42.3% of high-risk, insured, and having experienced medical mistreatment were vaccinated. 

New Haven study: “Association of influenza vaccine uptake with  health, access to healthcare, and medical mistreatment”

Gilstad-Hayden K, Durante A, Earnshaw VA, Rosenthal L, Ickovics JR. Association of influenza vaccine uptake with health, access to health care, and medical mistreatment among adults from low-income neighborhoods in New Haven, CT: a classification tree analysis. Prev Med. 2015;74:97-102. doi:10.1016/j.ypmed.2015.02.008

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390513/


Association of influenza vaccine uptake with health, access to health care, and medical mistreatment among adults from low-income neighborhoods in New Haven, CT: A classification tree analysis

- Low vaccine uptake: Those who are both high-risk and uninsured; Healthy adults 
- Moderate vaccine uptake: Those who are high-risk, insured, and experienced medical mistreatment 
- High vaccine uptake: Those who are high risk, insured, and never experienced medical mistreatment 


Vaccine-uptake subgroups formed from New Haven study relating to Insurance, High-risk Conditions, and Medical Mistreatment

Those who reported no high risk conditions had a lower vaccine uptake (39.9%) than those at risk (45.3%). Healthy adults were sorted into the low vaccine uptake subgroup. Healthy individuals may believe the risk associated with influenza to be low, which may be a barrier to influenza vaccination uptake. 

Health status (High risk vs no high-risk conditions) in relation to  Vaccine uptake 

Health insurance in relation to Vaccine uptake 

Medical mistreatment by a healthcare professional likely reduces the chances of utilizing healthcare. Low-income communities and communities of color may experience more mistreatment by the medical system. It was also found that even infrequent experiences of mistreatment could have a large effect on vaccination uptake. Among high-risk, insured individuals, 45% of those who experienced mistreatment were vaccinated, compared to 62.2% who did not experience mistreatment. 

 Medical Mistreatment in relation to Vaccine uptake 

The findings from this study show that increasing access to health care is not sufficient to significantly increase vaccine coverage because many adults who were insured and high-risk were not vaccinated (42.5%). However, access to care is still an important factor for vaccination uptake. Therefore, ways to provide free or low-cost influenza vaccinations can help increase vaccination uptake among uninsured individuals (especially those at high-risk) until barriers to healthcare access are fully addressed.

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