Trends in influenza vaccine disparities in the U.S. following the introduction of COVID-19: Insights from the national health interview survey

Seasonal influenza vaccination coverage in the US remains below the Healthy People 2030 goal of 70 % and differs by race and ethnicity. This study examines the impact of flu risk factors and healthcare access on racial and ethnic disparities in coverage. We estimated vaccination coverage among the US population (≥6 months) using 2020–2023 National Health Interview Survey data collected August–June. Coverage was estimated via Kaplan Meier analysis and self-reported vaccination between July and May in the prior 12 months. In the analytic sample ( N = 131,147), vaccination coverage ranged between 49.1 % (CI: 48.2,50.0 %) in 2021–2022 to 50.1 % (CI:49.2,51.0 %) in 2022–2023. Non-Hispanic Black people had the lowest coverage for all seasons but experienced the second largest increase in coverage (7.45 CI:3.38,11.30 percentage points). Vaccination coverage declined among non-Hispanic White people by 2.7 (CI:1.3,4.2 percentage points), with the greatest declines in this group among children 0–4 years (9.2 CI:0.5,17.1 percentage points) and insured people with financial barriers to healthcare (6.5 CI:2.4,11.1 percentage points). Despite notable gains among historically unvaccinated populations, disparities persisted and coverage among non-Hispanic Black people remained substantially below the Healthy People 2030 goal. Study findings suggest that addressing financial barriers and targeted messaging may help improve uptake. • From 2020 to 21 to 2022–23, flu vaccine coverage rose for all but NH-White people. • NH-Black people, historically least vaccinated, saw a large increase in coverage. • Among NH-Black people, biggest gains were in youth, high-risk, and insured with barriers. • Declines among NH-White people were largest in age 0–4 and with financial barriers.