**Summaries for Box 4_Disparities_Tables 1-10**

**BOX 4_ Disparities /TABLE 1. Summary table of racial/ethnic* differences in vaccination coverage among adults aged ≥19 years, by age group and increased-risk status† — National Health Interview Survey, United States, 2017**

With whites as the reference group, there were differences in vaccination coverage for 49 of the 66 comparisons by vaccine and age/target groups (not including comparisons of the “other” race/ethnic group). These vaccination differences ranged from 11.4 percentage points for Asians compared with whites for hepatitis B vaccination among health care personnel (HCP) aged ≥19 years to -25.5 percentage points for blacks compared with whites for herpes zoster vaccination among adults aged ≥65 years.

**BOX 4_ Disparities /TABLE 2. Average change in racial/ethnic* percentage point differences† in vaccination coverage among adults aged >19 years compared with whites, by age group and increased-risk status§ — National Health Interview Survey, United States, 2010-2017**

During 2010–2017, vaccination differences between whites and blacks increased for tetanus vaccination**(**tetanus and diphtheria toxoids (Td) or Tdap) (adults aged ≥19 years and aged 19-49 years), Tdap (adults aged ≥19 years, aged 19-64 years, and aged ≥65 years), hepatitis A (adults aged 19–49 years), hepatitis B (adults aged 19-49 years and HCP aged ≥19 years), and herpes zoster vaccination (adults aged ≥60 years and aged ≥65 years) (test for trend: p<0.05). Among Hispanics, vaccination differences increased over this time period compared with whites for tetanus vaccination (Td or Tdap) (adults aged ≥19 years), Tdap (adults aged ≥19 years, aged 19–64 years, and aged ≥65 years), hepatitis A (adults aged 19–49 years), hepatitis B (HCP aged ≥19 years), and herpes zoster vaccination (adults aged ≥60 years and aged ≥65 years) (test for trend: p<0.05). For Asians, vaccination differences increased over this time period compared with whites for Tdap (adults aged 19–64 years), and herpes zoster vaccination (adults aged ≥65 years) (test for trend: p<0.05). Vaccination differences between whites, blacks, Hispanics, and persons reporting other race for the other vaccines and age groups did not change during this period.

**BOX 4_ Disparities /TABLE 3. Estimated proportion of adults ≥19 years who received influenza, by age group, increased-risk status, and race/ethnicity* — National Health Interview Survey, United States, 2017**

Influenza vaccination coverage for the 2016-17 season overall among adults >19 years was 45.4%, a 1.9 percentage points increase from the 2015-2016 season. Coverage among whites >19 years (48.2%) was higher than that for blacks (38.5%) and Hispanics (37.0%).****

Among adults 19-49 years, influenza vaccination coverage for the 2016–17 season overall increased by 2.4 percentage points to 34.5% compared with the 2015–16 season estimate. In the 2016-17 season, coverage among whites 19-49 years (35.3%) was higher than that for blacks (29.6%); coverage among whites was lower than that for Asians (42.6%). Coverage among whites 50-64 years (48.8%) was higher compared with blacks (41.8%) and Hispanics (40.0%). Coverage among whites >65 years (72.4%) was higher compared with blacks (64.4%).

**BOX 4_ Disparities /TABLE 4. Estimated proportion of adults ≥19 years who received any tetanus and Tdap vaccination, by age group, increased-risk status, and race/ethnicity* — National Health Interview Survey, United States, 2017**

In 2017, whites had higher tetanus vaccination coverage across all age groups compared with blacks, Hispanics, and Asians. Whites had higher Tdap coverage across all age groups compared with blacks and Hispanics, and higher coverage compared with Asians among adults ≥19 years and 19-64 years.

**BOX 4_ Disparities /TABLE 5. Estimated proportion of adults ≥60 years who received herpes zoster vaccination, by age group and race/ethnicity* — National Health Interview Survey, United States, 2017**

Among adults 60-64 years, 22.4% reported herpes zoster vaccination, similar to the estimate for 2016. Whites 60-64 years had higher herpes vaccination coverage (24.8%) compared with blacks (12.7%), and Hispanics (17.3%). Among adults >65 years, 40.2% reported herpes zoster vaccination, similar to the estimates for 2016. Whites >65 years had higher herpes zoster vaccination coverage (45.0%) compared with blacks (19.4%), Hispanics (21.4%), Asians (36.8%), and adults indicating other race/ethnicity (31.3%). Coverage was 45.0% among whites ≥65 years, a 3.3 percentage point increase from 2016. Compared with 2016 estimates, coverage among Asians (36.8%) increased 13.5 percentage points; coverage among adults indicating other race/ethnicity (31.3%) decreased 6.6 percentage points.****The difference in vaccination coverage between whites and other racial/ethnic groups in 2017 increased only for respondents >65 years indicating other race/ethnicity and decreased only for Asians >65 years compared with differences measured in 2016.

**BOX 4_ Disparities /TABLE 6. Estimated proportion of adults aged ≥19 years who received selected vaccinations, by age group, increased-risk status,* and health insurance status† — National Health Interview Survey, United States, 2017**

Vaccination coverage was lower among adults without health insurance compared with those with health insurance for influenza vaccination (aged ≥19 years, 19-49 years, and 50-64 years); pneumococcal vaccination (aged 19-64 at increased risk); tetanus vaccination (aged ≥19 years, 19-49 years, and 50-64 years); tetanus vaccination including pertussis vaccine (aged ≥19 years, and 19-64 years); hepatitis A vaccination (aged ≥19 years overall and among travelers); hepatitis B vaccination (aged ≥19 years, 19-49 years, and ≥19 years among travelers); and human papillomavirus (HPV) vaccination among females (aged 19-26 years). The difference in coverage between those with health insurance compared with those without health insurance ranged from 4.1 percentage points for hepatitis A among adults aged ≥19 years to 29.4 percentage points for influenza vaccination among those aged ≥19 years.

Vaccination coverage was higher among adults with private health insurance compared with those with public health insurance for pneumococcal vaccination among adults aged ≥65 years; tetanus vaccination (all ages); tetanus vaccination including pertussis vaccine (all ages); overall hepatitis A vaccination among adults aged ≥19 years (overall and travelers); hepatitis B vaccination among adults aged ≥19 years (overall, travelers, and those with diabetes),  and aged 19-49 years, and aged ≥60 years with diabetes; herpes zoster vaccination (all ages); and HPV vaccination among females aged 19-26 years. Vaccination coverage was lower among adults with private insurance compared with those with public insurance for influenza vaccination among adults aged ≥19 years (46.7% versus 52.7%, respectively) and pneumococcal vaccination among adults aged 19-64 years at increased risk (22.6% versus 33.1%, respectively). 

Influenza vaccination coverage was lower among adults aged 19-49 years across insurance status categories compared with adults aged 50-64 years and ≥65 years. Pneumococcal vaccination coverage was lower among adults with health insurance aged 19-64 years at increased risk compared with adults with health insurance aged ≥65 years. Compared with adults with health insurance aged 19-49 years, tetanus vaccination coverage was lower among adults with health insurance aged ≥65 years. Tetanus vaccination including pertussis vaccine coverage was lower among adults with health insurance aged ≥65 years compared with adults with health insurance aged 19-64 years. Hepatitis B vaccination coverage among adults with diabetes aged ≥60 years with health insurance was lower compared with coverage among adults with health insurance aged 19-59 years with diabetes. Herpes zoster coverage among adults with health insurance aged ≥65 years was higher compared with coverage among adults with health insurance aged 60-64 years.

**BOX 4_ Disparities /TABLE 7. Estimated proportion of adults aged ≥19 years who received selected vaccinations, by age group, increased-risk status,* health insurance status,† and having a usual place for health care — National Health Interview Survey, United States, 2017**

Generally, adults with a usual place for health care were more likely to report having received recommended vaccinations than those who did not have a usual place for health care, regardless of whether they had health insurance. Among adults with health insurance, coverage was higher among those who reported having a usual place for health care compared with those who did not have a usual place for health care for influenza vaccination (all ages); pneumococcal vaccination (all ages); tetanus vaccination and tetanus vaccination including pertussis vaccine (all ages); herpes zoster vaccination (aged ≥60 years and ≥65 years); and HPV vaccination (males aged 19-26 years). Among adults with health insurance, vaccination coverage was higher among those without a usual place of care compared with those with a usual place of care for hepatitis A (aged ≥19 years), and hepatitis B vaccination (aged ≥19 years overall and among travelers). Among adults without health insurance, coverage was higher among adults who had a usual place for health care compared with those who did not for influenza vaccination among adults aged ≥19 years; pneumococcal vaccination among adults aged 19–64 years at increased risk; tetanus vaccination among adults aged ≥19 years, 19-49 years, and 50-64 years; tetanus vaccination including pertussis vaccine among adults aged ≥19 years and 19-64 years; and hepatitis B vaccination among adults aged 19-49 years. 

Among adults with health insurance and a usual place for healthcare, influenza vaccination coverage was lower among adults aged 19-49 years (39.6%) compared with adults aged 50-64 years (51.2%) and ≥65 years (72.8%), and pneumococcal vaccination coverage was lower among adults aged 19-64 years (27.2%) at increased risk compared with adults aged ≥65 years (70.3%). Compared with adults aged 19-49 years (67.1%), tetanus vaccination coverage was lower among adults aged ≥65 years (61.4%), while tetanus vaccination including pertussis vaccine coverage was lower among adults aged ≥65 years (24.9%) compared with adults aged 19-64 years (37.1%). Hepatitis B vaccination coverage among adults with diabetes aged ≥60 years (12.9%) was lower compared with coverage among adults aged 19-59 years with diabetes (25.7%). Herpes zoster coverage among adults aged ≥65 years (41.1%) was higher compared with coverage among adults aged 60-64 years (25.0%). Similar differences in coverage by age were observed among adults with health insurance without a usual place of care for influenza vaccination, pneumococcal vaccination, tetanus vaccination, and tetanus vaccination including pertussis vaccine. Among persons without health insurance, few comparisons by age could be made since many of the estimates were suppressed due to small sample size (n<30) or relative standard error (standard error/estimates) >0.3.

**BOX 4_ Disparities /TABLE 8. Estimated proportion of adults aged ≥19 years who received selected vaccinations, by age group, increased-risk status,* health insurance status,† and physician contacts§ — National Health Interview Survey, United States, 2017**

Vaccination coverage was generally higher among those reporting having at least one physician contact in the past year compared with those who had not visited a physician in the past year, regardless of whether the respondent had health insurance, and vaccination coverage generally increased with increasing physician contacts. Hepatitis A vaccination coverage among persons aged ≥19 years, travelers aged ≥19 years, and persons with chronic liver conditions aged ≥19 years did not differ by number of physician contacts.

Among adults who had health insurance and reported having had ≥10 physician contacts within the past year, 21.0%–87.9% reported not receiving a vaccine or vaccine series that either is recommended for all persons or are recommended for those with some specific indication (not receiving influenza vaccination) (100 minus vaccination coverage), 40.6% [aged ≥19 years], 52.2% [aged 19–49 years], 43.2% [aged 50–64 years], 21.0% [aged ≥65 years]; not receiving pneumococcal vaccination, 60.7% [increased risk, aged 19–64 years], 24.1% [aged ≥65 years]; not receiving tetanus vaccination, 29.7% [aged ≥19 years], 25.9% [aged 19-49 years], 27.7% [aged 50-64 years], 36.9% [aged ≥65 years]; not receiving tetanus vaccination including pertussis vaccine, 62.4% [aged ≥19 years], 57.4% [aged 19–64 years], 74.0% [aged ≥65 years]; not receiving hepatitis A vaccination, 87.9% [aged ≥19 years], 79.2% [travelers aged ≥19 years], 75.1% [chronic liver conditions aged ≥19 years] ; not receiving hepatitis B vaccination, 72.2% [aged ≥19 years], 57.2% [aged 19-49 years], 62.2% [travelers aged ≥19 years], 63.8% [persons aged ≥19 years with chronic liver conditions], 80.1% [aged ≥19 years with diabetes], 69.4% [adults aged 19–59 with diabetes], 87.5% [adults aged ≥60 years with diabetes]; not receiving herpes zoster vaccination, 61.6% [adults aged ≥60 years], 75.0% [60-64 years], 56.9% [≥65 years]; and not receiving HPV vaccination, 46.6% [females aged 19–26 years]).

Among adults with health insurance and at least one physician contact, influenza vaccination coverage was lower among adults aged 19-49 years compared with adults aged 50-64 years and ≥65 years, and among adults with health insurance and no physician contacts, influenza vaccination coverage was lower among adults aged 19-49 years compared with adults ≥65 years. Among adults with health insurance regardless of number of physician contacts, pneumococcal vaccination coverage was lower among adults aged 19-64 years at increased risk compared with adults aged ≥65 years, and compared with adults aged 19-49 years, tetanus vaccination coverage was lower among adults aged ≥65 years, while tetanus vaccination including pertussis vaccine coverage was lower among adults aged ≥65 years compared with adults aged 19-64 years. Among adults with health insurance and at least one physician contact, hepatitis B vaccination coverage among adults with diabetes aged ≥60 years was lower compared with coverage among adults aged 19-59 years with diabetes, and herpes zoster coverage among adults aged ≥65 years was higher compared with coverage among adults aged 60-64 years.

**BOX 4_ Disparities /TABLE 9. Adjusted vaccination coverage among adults aged ≥19 years, by age group, increased-risk status,* and health insurance status† — National Health Interview Survey, United States, 2017**

Adults without health insurance were significantly less likely than those with health insurance to be vaccinated after adjusting for confounders for influenza (aged ≥19 years); hepatitis A (aged ≥19 years and travelers aged ≥19 years); hepatitis B (aged ≥19 years and 19-49 years); and herpes zoster (age ≥60 years) vaccination. The difference in adjusted vaccination coverage between respondents with and without health insurance for whom the difference was statistically significant ranged from 3.7% (hepatitis A vaccination among adults aged ≥19 years) to 26.5% (herpes zoster vaccination among adults aged ≥60 years).

**BOX 4_ Disparities /TABLE 10. Estimated proportion of adults aged ≥19 years who received selected vaccinations, by age group, increased-risk status,* nativity,† number of years living in the United States, and citizenship — National Health Interview Survey, United States, 2017**

Nativity was categorized as U.S.-born (persons born in one of the 50 States or the District of Columbia); or foreign-born (persons who were not born in one of the 50 States or the District of Columbia).

Generally, vaccination coverage among U.S.-born respondents was significantly higher than that of foreign-born respondents including pneumococcal vaccination (all ages), tetanus vaccination**(**tetanus and diphtheria toxoids [Td or Tdap] vaccination [all ages]), Tdap vaccination (all ages), hepatitis A vaccination among travelers aged ≥19 years, hepatitis B vaccination (all ages), herpes zoster vaccination (all ages), and HPV vaccination among females and males aged 19-26 years.

Vaccination coverage was significantly lower for foreign-born persons living in the United States ≥10 years compared with those living in the United States <10 years for hepatitis A vaccination (adults aged ≥19 years overall and among travelers aged ≥19 years) and hepatitis B vaccination (adults aged ≥19 years overall, travelers aged ≥19 years, and 19-49 years). Coverage among foreign-born adults who were U.S. citizens was higher than that for foreign-born adults who were not U.S. citizens for influenza vaccination (adults aged ≥19 years and 50-54 years); hepatitis B vaccination (adults aged 19-49 years); and herpes zoster vaccination (adults aged ≥60 years).

Influenza vaccination coverage was lower among adults aged 19-49 years compared with adults aged 50-64 years and ≥65 years among U.S.-born adults, foreign-born adults, and foreign-born adults who lived in U.S. ≥10 years and who reported being U.S. citizens. Pneumococcal vaccination coverage was lower among adults aged 19-64 years at increased risk compared with adults aged ≥65 years. Compared with adults aged 19-49 years, tetanus vaccination coverage was lower among adults aged ≥65 years among U.S.-born, foreign-born adults, and foreign-born adults who live in U.S. ≥10 years and who are U.S. citizens. Where comparisons could be made, tetanus vaccination including pertussis vaccine coverage was lower among adults aged ≥65 years compared with adults aged 19-64 year. Hepatitis B vaccination coverage among adults with diabetes aged ≥60 years among U.S.-born adults was lower compared with coverage among adults aged 19-59 years with diabetes, and herpes zoster coverage among adults aged ≥65 years was higher compared with coverage among adults aged 60-64 years among U.S.-born, foreign-born adults, and foreign-born adults who live in U.S. ≥10 years and who are U.S. citizens. 

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