Seasonal Influenza Vaccination among Homebound Elderly Receiving Home-Based Primary Care in New York City

Seasonal influenza vaccination is recommended for all persons aged ≥50 years to reduce influenza related morbidity and mortality,
but vaccination coverage among community-dwelling elderly remains low. Homebound elderly receiving home-based primary care
(HBPC) have fewer barriers to vaccination than other community-dwelling elderly. The Mount Sinai Visiting Doctors (MSVD) program
provides HBPC to homebound elderly in New York City. This study assessed seasonal influenza vaccination coverage within an
urban HBPC program and identified factors associated with vaccine refusal. A cross-sectional analysis of data from the 2008–2009
influenza season was completed and influenza vaccination coverage was assessed. The association between social, demographic
and health-related characteristics and vaccine refusal was evaluated using bivariate analysis and multivariable logistic regression.
Of 689 people aged >65 eligible for influenza vaccination, 578 (84%) accepted and 111 (16%) refused vaccination. In multivariable
analysis, vaccine refusal was positively associated with female gender (adjusted odds ratio [AOR] = 1.85, 95% confidence interval
[CI] 1.02, 3.35), black race (AOR = 2.04, 95% CI 1.28, 3.25), and living alone (AOR = 1.71, 95% CI 1.10, 2.67), and negatively
associated with dementia (AOR = 0.59, 95% CI 0.37, 0.91). Seasonal influenza vaccine coverage in the MSVD program was high
compared to nursing home and community-dwelling elderly. Offering patients vaccination at home without additional expense
will likely improve vaccine coverage among urban homebound elderly. Understanding why vaccine refusal rates are higher among
females, black patients, and those living alone should guide interventions to increase vaccine acceptance among this population.