Medical Expenditure Panel Survey Agency for Healthcare 

Research and Quality

STATISTICAL BRIEF #114 

February 2006 

Annual Flu Shot Rates among Persons 

18 and Older in the U.S. Civilian 

Noninstitutionalized Population, 2003 

Highlights 

 In 2003, while less than a fifth 

(18.8 percent) of the 18–49 

age group received a flu shot 

within the last year, 40.7 percent of 50–64 year olds and 

two-thirds (66.4 percent ) of 

persons 65 and older received

flu shots. 

 Hispanic adults were less 

likely to receive flu shots than

non-Hispanic black or white 

adults (18.8 percent versus 

21.5 percent and 35.9 percent, respectively). 

 Among persons 18 and older, 

those with some college 

education were more likely 

than high school graduates or

those with fewer than 12 

years of education to have 

received a flu shot in the last 

year (34.3 percent versus 

30.7 percent 27.6 percent, 

respectively). 

 Adults ever diagnosed with

select chronic conditions 

(diabetes, asthma, high blood

pressure, or cardiovascular 

disease) were more likely to

receive flu shots than adults 

without any of these chronic 

health problems. 

 Adults who perceived

themselves to be in fair or 

poor health were substantially 

more likely to receive flu shots 

than those who thought themselves to be in very good or

good health or in excellent 

health (43.0 percent versus 

31.9 percent and 25.4 percent, respectively). 

Anita Soni, PhD 

Introduction 

Influenza is a contagious viral infection of the nose, throat, and 

lungs. Flu complications can include bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as

congestive heart failure, asthma, or diabetes. Flu season can begin 

as early as October and end as late as May. 

The Centers for Disease Control and Prevention recommend that 

persons who are at high risk of having serious flu complications get 

vaccinated each year. This includes all persons 65 years of age and 

older and persons with certain chronic conditions that weaken their 

ability to fight flu and its complications. Since many persons 50–64

years of age have one or more medical conditions that would place 

them at increased risk for serious complications from the flu, it is also 

recommended that all persons in this age group get yearly flu shots. 

This Statistical Brief uses data from the Household Component of 

the Medical Expenditure Panel Survey (MEPS-HC) for 2003 to 

examine receipt of annual flu shots for adults 18 or older in the U.S.

civilian noninstitutionalized population. The brief compares the 

percentages of persons getting an annual flu shot by various 

demographic characteristics and health status. All comparisons 

discussed in the text are statistically significant at the .05 level 

unless otherwise noted. 

Findings 

Demographics 

In 2003, an estimated 69.1 million or 31.7 percent of the 18 and 

older U.S. civilian noninstitutionalized population reported having 

received the influenza immunization within the last year. The rate of

flu vaccination was found to be positively correlated with age (figure 

1). Only 18.8 percent persons between the ages of 18 and 49 

reported receiving a flu shot within the last year, compared to 40.7 

percent of persons ages 50–64 and 66.4 percent of persons 65 or

older. 
Hispanic or Latino adults were less likely than non-Hispanic blacks or whites to have received a flu shot 

within the last year (18.8 percent versus 21.5 percent and 35.9 percent, respectively) (figure 2). 

Annual flu immunization rates were found to be strongly correlated with level of educational attainment. 

Adults having at least some college education were much more likely than their less-educated 

counterparts who only completed high school or had fewer than 12 years of education to have obtained a 

flu vaccination in the last 12 months (34.3 percent versus 30.7 percent and 27.6 percent, respectively) 

(figure 3). 

Women were somewhat more likely than men to have received a flu shot within the last year (34.9 

percent versus 28.3 percent) (estimates not shown). 

 

Health status and insurance 

Adults who have ever been diagnosed with diabetes, asthma, high blood pressure, or cardiovascular 

disease were more likely to have received a flu shot in the last year than those not having any of those 

conditions (figure 4). Among persons with none of the listed chronic conditions, 23.3 percent received the 

flu shot within the last year, as compared to 49.3 percent of adults having one or more of the chronic 

conditions. Specifically, among persons with diabetes and cardiovascular diseases, 59.8 percent received 

the vaccine within the last year. In addition, more than half (55.4 percent) of persons with high blood 

pressure and 39.1 percent of persons with asthma have received a flu shot within the past year. 

Similarly, adults who perceived themselves to be in fair or poor health were much more likely to have 

received a flu shot than those who perceived themselves to be in good or very good health or in excellent 

health (43.0 versus 31.9 percent and 25.4 percent, respectively) (figure 5). 

Persons 18–49 years of age who were privately insured or covered only by public health insurance were 

considerably more likely (21.8 percent and17.8 percent, respectively) than persons who were uninsured 

(7.5 percent) to have received a flu shot within the last year. Persons 50–64 years of age received the

flu shots within the last year at a much higher rate than those in the age group 18–49 across all insurance 

status categories. Among elderly adults (ages 65 and older), persons covered by Medicare plus private

(including TRICARE) insurance were slightly more likely than those covered by Medicare only to have

obtained a flu shot in the last year (69.4 percent versus 63.8 percent). Elderly persons covered by Medicare and some other public coverage program were least likely to have received a flu shot in the last 

year (57.1 percent) (figure 6). 

Data Source 

The estimates shown in this Statistical Brief are drawn from analyses conducted by the MEPS staff from 

the MEPS-HC public use file HC-073. 

Definitions 

Cardiovascular disease and stroke 

The indicator for cardiovascular disease and stroke was drawn from variables indicating presence of 

heart disease (coronary heart disease, angina, heart attack, stroke, or any other heart-related disease). 

For each of the conditions listed, the following question was asked: “(Have/Has) PERSON ever been told 

by a doctor or other health professional that PERSON had [condition].” 

Racial and ethnic classifications 

Classification by race and ethnicity was based on information reported for each family member. 

Respondents were asked if each family member’s race was best described as American Indian, Alaska 

Native, Asian or Pacific Islander, black, white, or other. They also were asked if each family member’s 

main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or 

Chicano; other Latin American; or other Spanish. All persons whose main national origin or ancestry was 

reported in one of these Hispanic groups, regardless of racial background, were classified as Hispanic. 

Since the Hispanic grouping can include black Hispanic, white Hispanic, Asian and Pacific Islanders 

Hispanic, and other Hispanic, the race categories of black, white, Asian and Pacific Islanders, and other 
do not include Hispanic. MEPS respondents who reported other single or multiple races and were nonHispanic were included in the other category. 

Health insurance status 

Individuals under age 65 were classified in the following three insurance categories, based on household 

responses to health insurance status questions: 

– Any private health insurance: Individuals who, at any time during the year, had insurance that provides 

coverage for hospital and physician care (other than Medicare, Medicaid, or other public 

hospital/physician coverage) were classified as having private insurance. Coverage by TRICARE 

(Armed Forces–related coverage) was also included as private health insurance. Insurance that 

provides coverage for a single service only, such as dental or vision coverage, was not included. 

– Public coverage only: Individuals were considered to have public coverage only if they met both of the 

following criteria: 1) they were not covered by private insurance at any time during the year, and 2) they 

were covered by one of the following public programs at any point during the year: Medicare, Medicaid, 

or other public hospital/physician coverage. 

– Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, 

Medicare, TRICARE, Medicaid, or other public hospital/physician programs at any time during the entire 

year or period of eligibility for the survey. 

For individuals 65 and older, the following insurance categories were used: 

– Medicare only: Individuals who, at any time during the year, were covered by Medicare only. This 

classification also includes a small number of persons ages 65 and over who did not report Medicare 

coverage. 

– Medicare plus private (including TRICARE): Individuals who at any time during the year, were covered 

by a combination of Medicare, TRICARE, or private insurance. 

– Medicare plus other public coverage: Individuals who, at any time during the year, were covered by 

Medicare in addition to some other type of public insurance. 

About MEPS-HC 

MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health 

care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, 

demographic, and economic characteristics for the civilian noninstitutionalized population. It is 

cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health 

Statistics. 

For more information about MEPS, call the MEPS information coordinator at AHRQ (301-427-1656) or 

visit the MEPS Web site at http://www.meps.ahrq.gov/. 

References 

Agency for Healthcare Research and Quality. National Healthcare Quality Report, 2004. Rockville, Md.: 

U.S. Department of Health and Human Services. 

Centers for Disease Control and Prevention. Influenza fact sheet: Key estimates about Influenza and the 

Influenza vaccine. Rev ed. Atlanta, Ga.: U.S. Department of Health and Human Services, Centers for 

Disease Control and Prevention: 2004. http://www.cdc.gov/flu/keyfacts.htm

For a detailed description of the MEPS survey design, sample design, and methods used to minimize 

sources of nonsampling error, see the following publications: 

Cohen, J. Design and Methods of the Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 1. AHCPR Pub. No. 97-0026. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 

Cohen, S. Sample Design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS 

Methodology Report No. 2. AHCPR Pub. No. 97-0027. Rockville, Md.: Agency for Health Care Policy and 

Research, 1997. 
Cohen, S. Design Strategies and Innovations in the Medical Expenditure Panel Survey. Medical Care,

July 2003: 41(7) Supplement: III-5–III-12. 

Suggested Citation 

Soni, A. Annual Flu Shot Rates among Persons 18 and Older in the U.S. Civilian Noninstitutionalized 

Population, 2003. Statistical Brief #114. February 2006. Agency for Healthcare Research and Quality, 

Rockville, Md. http://www.meps.ahrq.gov/papers/st114/stat114.pdf 

∗ ∗ ∗

AHRQ welcomes questions and comments from readers of this publication who are interested in 

obtaining more information about access, cost, use, financing, and quality of health care in the United 

States. We also invite you to tell us how you are using this Statistical Brief and other MEPS data and 

tools and to share suggestions on how MEPS products might be enhanced to further meet your needs. 

Please e-mail us at mepspd@ahrq.gov or send a letter to the address below: 

Steven B. Cohen, PhD, Director 

Center for Financing, Access, and Cost Trends 

Agency for Healthcare Research and Quality 

540 Gaither Road 

Rockville, MD 20850 
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2003.

18.8

40.7

66.4

31.7

0

20

40

60

80

100

All adults 18-49 50-64 65+

Percent

Figure 1. Percentage of adults receiving flu shots, 

by age, 2003

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2003.

28.4

35.9

21.5 18.8

0

20

40

60

80

100

Hispanic Black White Other

Percent

Figure 2. Percentage of adults receiving flu shots

by race/ethnicity, 2003
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2003.

34.3

30.7

27.6

0

20

40

60

80

100

<12 years High school graduate Some college

Percent

Figure 3. Percentage of adults receiving flu shots,

by educational status, 2003

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2003.

59.8

39.1

55.4

59.8

49.3

23.3

0

20

40

60

80

100

None One or more

conditions

Diabetes Asthma High blood

pressure

Cardiovascular

diseases

Percent

Figure 4. Comparison of adults receiving flu shots,

by diagnosed condition status, 2003
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2003.

25.4

31.9

43.0

0

20

40

60

80

100

Fair or poor Good or very good Excellent

Percent

Figure 5. Percentage of adults receiving flu shots,

by perceived health status, 2003

Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey 2003.

21.8

43.0

17.8

43.1

7.5

23.2

0

20

40

60

80

Age 18-49 Age 50-64

Private Public Uninsured

Figure 6. Percentage of adults receiving flu shots,

by insurance status, 2003

63.8

69.4

57.1

0

20

40

60

80

Age 65+

Medicare only Medicare+Private Medicare+Public

Percent