Commentary--anatomy of racial disparity in influenza vaccination.

The Institute of Medicine report, Unequal Treatment, documents the presence of racial/ethnic disparities in health care across multiple procedures. It concluded that stereotyping, biases, and uncertainty on the part of health care providers all contribute to unequal treatment while also acknowledging the role of access and patient factors (Institute of Medicine 2002). Yet, despite the large number of studies documenting disparities in health care, few have sought to quantify the relative role of provider, patient, and access factors to disparities. Large racial/ethnic disparities have been consistently documented in use of expensive, invasive technology including coronary revascularization procedures (Epstein et al. 2003), organ transplantation (Ayanian et al. 1999; Epstein et al. 2000), cerebrovascularization management and treatment (Lillie-Blanton et al. 2002), and knee and hip arthroplasty (Institute of Medicine 2002; Skinner et al. 2003). Disparities have been less consistently documented in the provision of primary care procedures. For example racial/ethnic disparities in screening for breast, cervical, colon, and prostate cancer range from small to nonsignificant (Swan et al. 2003). A study of directly observed primary care visits showed no evidence in racial disparity in care (Williams, Flocke, and Stange 2001). However, elderly African Americans and Hispanics consistently report lower rates of influenza vaccines. In 2002, only 48.5 percent of elderly African Americans and 50.7 percent of Hispanics reported receiving the vaccine compared with 69.6 percent of whites (Centers for Disease Control and Prevention 2003).