Seasonal flu vaccination rates are lower in dialysis facilities with greater proportions of Black and Hispanic patients, according to a new study. These disparities could have implications for future COVID-19 vaccination efforts.

Across 6735 dialysis facilities, a mean 72.1% of patients received a seasonal flu vaccination during the peak flu season, August through December. Facilities with higher proportions of Black and Hispanic patients had significantly lower vaccination rates than less diverse facilities, John Danziger, MD, MPhil, of Beth Israel Deaconess Medical Center in Boston, Massachusetts, and colleagues reported in the Journal of the American Society of Nephrology. For every 10% increment in Black or Hispanic patients attending a facility, 0.60% and 0.79% fewer patients, respectively, received vaccination (both P <.001).

Seasonal influenza vaccination also decreased more over time in facilities serving more ethnic minority patients. Overall, the average proportion of patients vaccinated at each facility decreased by a significant 1.05% per year from 2014 to 2017 (P <.001), but was most apparent among facilities with higher proportions of Black and Hispanic patients. Facilities in the quartile with the lowest proportion of Black patients had a 0.82% (P <.001) annual rate of decline in vaccinations compared with a 1.21% rate of decline (P <.001) among facilities in the quartile with the highest proportion of Black patients. Investigators observed a similar trend for Hispanic patients.

Dialysis facilities did not vaccinate approximately 25% of their patients, but those with greater proportions of Black and Hispanic patients were more likely to undervaccinate. These more diverse dialysis facilities tended to be larger, not-for-profit centers with older patients. However, the reasons for the ethnic disparities in flu vaccination have yet to be determined.

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“The failure to uniformly vaccinate patients seen in facilities with larger minority populations has important implications for those individuals and for their communities, and is a missed opportunity to protect the most vulnerable,” Dr Danziger stated in a news release from the American Society of Nephrology. “This study is particularly relevant since the COVID-19 epidemic will almost certainly require a large-scale vaccination campaign. By highlighting the disparities in vaccination facing minorities, who are at highest risk of COVID-19 complications, our study underscores which populations are at greatest need for vaccination outreach programs.”


Danziger J, Weinhandl E, Friedman D, Mukamal KJ. Racial and ethnic disparities in seasonal influenza vaccination rates among dialysis facilities in the United States. J Am Soc Nephrol. Published online August 13, 2020. doi:10.1681/ASN.2020040483

Study uncovers racial and ethnic disparities in flu vaccination rates among US dialysis facilities [press release]. Washington DC: American Society of Nephrology; August 13, 2020.