Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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 (7.5 [CI:3.4,11.3 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]). CONCLUSIONS: 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.