Nationality at Birth Plays a Role in U.S. Adult Vaccination Rates


Nationality at birth appears to play a significant role in whether or not adults in the United States are routinely vaccinated for preventable diseases, a new study in the American Journal of Preventive Medicine finds, reflecting a risky medical lapse for more than one in ten people nationwide.

Foreign-born adult U.S. residents, who make up about 13 percent of the population, receive vaccinations at significantly lower rates than U.S.-born adults. This gap poses special risks for certain groups of people who are vulnerable to many serious and sometimes deadly diseases that vaccines can prevent.

The study’s lead author, Peng-Jun Lu, MD, PhD, a researcher at the Center for Disease Control and Prevention, noted the rise in the foreign-born population in the United States, which stood at only five percent in 1970.

“As their numbers continue to rise, it will become increasingly important to consider this group in our efforts to increase vaccination and eliminate coverage disparities,” he said.

Lu and his co-authors observed, “The prevalence of most vaccine-preventable diseases in the U.S. is at or near record lows, although many of these diseases remain endemic in other countries”. Foreign-born residents from those countries and their relatives in the United States are at greater risk of exposure to several vaccine-preventable diseases, either prior to migrating to the U.S. or during return visits to their home countries.

The researchers analyzed 2012 National Health Interview Survey (NHIS) data to compare rates for eight types of vaccinations among adults. Vaccinations included were: influenza; PPV to prevent pneumococcal diseases, especially pneumonia; tetanus; Tdap, which prevents tetanus, diphtheria and pertussis; hepatitis A; hepatitis B; shingles; and HPV, the human papilloma virus, which can lead to some types of cancer.

The data comparisons found dramatic discrepancies. For example, 40 percent of U.S.-born adults received recommended influenza vaccination, compared to 34 percent of foreign-born adults in the same age groups. For tetanus, the gap was 65 percent of U.S.-born adults vaccinated as recommended, compared to 51 percent of foreign-born adults. And for shingles, the gap was especially prominent: 21 percent of U.S.-born adults in the target age range received the vaccination, compared with just 12 percent of foreign-born adults.

Among foreign-born adults, Hispanic people had significantly lower coverage for most vaccinations compared with those of other backgrounds. Foreign-born U.S. residents from Latin America account for more than half of all foreign-born adults in the nation, the authors wrote.

Vaccination rates were even lower for those foreign-born adults who had not become citizens or who had recently arrived to the United States, compared to naturalized citizens. In prior studies, people in these two groups experienced reduced access to care.

Daniel Salmon, associate professor of international health at Johns Hopkins Bloomberg School of Public Health, noted that foreign-born adults in this study were less likely to speak English, have an advanced education or live above the poverty line. Salmon also said the study showed that, while “there is a lot of room for improving adult vaccination rates across all U.S. populations,” the foreign-born adults experience an especially high risk of missing the benefits of vaccination.

Salmon called the new findings “very important” for health care providers, community-based organizations, and local and state health authorities. He suggested that such service providers consider including “vaccination in non-traditional settings like ethnic fairs and workplaces, to capture foreign-born people who may have limited access to the health care system.”                      

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For More Information:

Peng-jun Lu et al. Adult Vaccination Disparities Among Foreign-Born Populations in the U.S. American Journal of Preventive Medicine. DOI:

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