Indirect Clinical Impact of COVID on Children, Part 2: Flu Shot Racial Disparities

Executive summary: imperfect, but compelling, evidence shows that not only are there racial disparities with flu shot administration, it has gotten worse in 2020.

Let's be clear from the top - this data doesn't tell the entire story.  Not only is clinical data sometimes difficult to interpret, but when you add SDOH to the mix, especially race, things get much more complicated.

In an effort to boil of the variables as much as possible, I asked my crew for a quick examination of a specific data set: looking at all the children who have visited PCC clients in 2020, for those who have a race listed in their demographics, how many have received a flu vaccine from the practice and how does that compare to the same time frame in 2019?

The results are sadly expected:

Space limited my column titles, so let's review:

• AI+ = American Indian or Alaska Native
• AA = African American or Black
• NH+ = Native Hawaiian or Other Pacific Islander

The immediate conclusions to reach from this data should be two-fold: first, American Indians, African Americans, and Native Hawaiian populations have seen a reduction in flu shot volume in 2020 so far.  Second...African Americans already lagged all other populations.  Significantly.

The two populations with the highest administration rate in 2019 - Asian and White - have actually increased in 2020.  

This data has many flaws:

• it's a much smaller sample of patients than usual PCC data (6-700K patients vs. a few million);
• race is subjective and self-reported;
• distribution of patient race tracking is not even across PCC clients;
• we looked only at flu shots given by our clients, not for actual flu coverage;
• both measures include flu shots given in the first part of each year, so January 2020 flu shots are counted for 2020 (for example) and not 2019, as they should clinically;
• we're not tracking year-to-year results for a specific patient set (i.e., patient A is tracked in 2019 and 2020).  In fact, it's possible for patients to appear in one group in 2019 and a different in 2020.

...I could keep going, but the story remains the same.  If we look at the race of the patients who received flu shots so far in 2020, not only do some BIPOC populations have lower rates of flu vaccination, it's getting worse for some.

I welcome input, of course.