Introduction: Only 53% of American adults receive influenza vaccination, and disparities in vaccination exist among particular racial and ethnic groups. This study determines how race, ethnicity, sex, and rurality are associated with influenza vaccination adherence in a national Veteran Health Affairs Administration cohort.

Methods: The authors examined differences in documented influenza vaccinations for the 2019-2020 influenza season among Veteran Health Affairs Administration patients in a retrospective cohort study using Veteran Health Affairs Administration administrative electronic health record data. The author used logistic regression to model receipt of influenza vaccination in association with race, ethnicity, sex, and rurality while controlling for clinical diagnoses, demographics, and ambulatory care utilization. The authors also stratified the models by sex and rurality.

Results: Among 5,943,918 veterans, 48.6% received influenza vaccination. Unadjusted comparisons showed that those who were vaccinated were more likely to be White, to be of male sex, and to be older. Similar proportions of unvaccinated and unvaccinated veterans were from rural settings. In adjusted models, Black race was most strongly associated with decreased vaccination (AOR=0.69; 95% CI=0.69, 0.70), and American Indian/Alaskan Native race also had reduced odds of vaccination (AOR=0.94; 95% CI=0.92, 0.95) compared with White race. Female veterans had increased odds of vaccination (AOR=1.20; 95% CI=1.19, 1.20) compared with men. Rurality (AOR=0.97; 95% CI=0.96, 0.97) was associated with a small decreased odds of vaccination compared with urban. In stratified models, Black veterans were less likely to receive influenza vaccination regardless of sex and rurality than White veterans. American Indian/Alaska Native female veterans had equal odds of vaccination as White female veterans, whereas American Indian/Alaska Native male veterans had reduced odds of vaccination compared with White male veterans.

Conclusions: During the 2019-2020 influenza season, Black and American Indian/Alaskan Native veterans had lower odds of vaccination. Despite the Veteran Health Affairs Administration's universal approach to healthcare, racial disparities still exist in preventive care.