Abstract
Background: Current guidelines promulgate annual influenza immunization and pneumococcal vaccination in cancer patients. Cancer disparities in preventive services affected by multiple socioeconomic and behavioral factors have not been studied systematically. The goal of this study was to identify potential disparities in influenza and pneumonia vaccinations and to analyze association of socioeconomic factors and health behaviors in delivery of immunization preventive services in adult cancer survivors. Methods: Data from the National Health Interview Survey (NHIS) from 2010 to 2018 were used to analyze vaccination status among adult cancer survivors. After pooling the data with proportionally adjusted weights, SAS procedures PROC SURVEYFREQ and PROC SURVEYLOGISTIC were performed to adjust for hierarchical sampling. Chi-square tests were applied to determine whether differences in vaccination prevalence stratified by patient characteristics were statistically significant. Multiple logistic regression was used to estimate the association between predictors (racial/ethnic groups, gender, education, income, body mass index (BMI), marital, smoking and drinking status) and immunization services. Results: Overall, 16,450 (63.4%) and 14,489 (54.1%) cancer survivors reported having a flu shot and pneumonia immunization, respectively, with over 90% of them being non-Hispanic. Also, 90.2% of cancer patients with flu shots and 91.1% with pneumococcal vaccination were White. The lowest influenza vaccination rate was found in cancer patients with low socioeconomic status (less than 12 years of education: 9.4%, total income below the poverty threshold of the year: 6.7%, single people: 5.8%). Lower immunization rates were associated with poor health behaviors. Results further indicated that racial/ethnic, as well as socioeconomic status disparities in flu and pneumonia immunization, were maximal at the aggregate level: Non-Hispanic cancer patients had higher immunization rates than Hispanic patients. Immunization rates in Asians and Whites were much higher than in Blacks and other races. Additionally, gender disparity in immunization was found with women having significantly lower immunization rates. After adjusting for covariates, logistic regression demonstrated that Hispanic cancer patients had 0.66 and 0.54 times the probability of having flu and pneumonia immunization as compared to non-Hispanic patients, respectively. Comparing to Whites, Odds Ratio of having flu shot for Blacks was 0.73 (0.64-0.83, p<0.0001) Conclusions: Our analysis demonstrated significantly higher odds of receiving flu and pneumonia vaccination by non-Hispanic cancer patients as compared with Hispanic cancer patients. People with higher socioeconomic status were more likely to receive preventive services than those with low socioeconomic status. Significant disparity existed in immunization of Blacks as compared to White and Asians.
Citation Format: Xingyue Huo, Joseph Finkelstein. Factors affecting disparities in delivery of preventive services to cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-195.
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