Cultural values may explain low vaccination rates for diabetic minorities

February 05, 2003

Minorities with diabetes are less likely to be vaccinated for the flu and pneumonia than whites are -- even when they have equal healthcare access, insurance and socioeconomic status, a new study finds. Cultural values held by minorities as well as healthcare providers may help explain this, the researchers say.

"A better understanding of how differences in the cultural beliefs and values of healthcare providers and patients influence recommendation of services by providers and acceptance of health services by patients" is necessary, according to study author Leonard E. Egede, M.D., M.S., of the Department of Medicine at the Medical University of South Carolina in Charleston.

Currently "there are missed opportunities for vaccination of individuals with diabetes in primary care settings, particularly minority individuals," he adds.

Diabetes is more common among minorities, and African-Americans and Hispanics with this chronic disease have higher death rates and suffer more complications than whites do. Because having diabetes increases vulnerability to the flu and pneumonia, current guidelines recommend flu and pneumonia shots for diabetics.

Egede and study co-author Deyi Zheng Ph.D., M.B., from the Medical University of South Carolina's Department of Biometry and Epidemiology examined data on 1,906 diabetic adults. The researchers gathered the information from the National Health Interview Survey, a household survey sponsored by the National Center for Health Statistics.

Approximately half of the diabetic adults had received a flu shot, and 33 percent had received a pneumonia vaccine. The Healthy People 2010 target vaccination rate for diabetic adults younger than 65 is 65 percent.

"Regrettably, vaccination rates for people with diabetes are a long way from this objective," Egede notes. "There is a need to improve vaccination coverage in primary care settings."

Egede's and Zheng's main study finding was lower vaccination rates among African-Americans and Hispanics than whites, which could not be explained away by racial or ethnic differences in healthcare access, insurance coverage and socioeconomic status. This finding suggests racial and ethnic variations extend beyond a mere consideration of socioeconomics.

"We need to devote research efforts toward identifying the true reasons for the observed racial/ethnic disparities in vaccination rates for people with diabetes," Egede says. The study results are published in the February 2003 issue of the American Journal of Public Health.

The study authors suggest that more research on shared social and cultural values among racial and ethnic groups may help deepen the understanding of the racial and ethnic differences often noted in study findings.

"Future studies on the relationship between culture and health outcomes need to do more than merely demonstrate an association between cultural differences and health outcomes," Egede concludes. "They must provide a causal pathway for any such association."

This study was supported in part by grants from the Agency for Healthcare Research and Quality in Rockville, Md., and the Centers for Disease Control and Prevention, in Atlanta, Ga.

Health Behavior News Service: 202-387-2829 or
Interviews: Contact Leonard E. Egede at
American Journal of Public Health: 202-777-2511 or

Center for Advancing Health

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