Rural–Urban Differences in Influenza Vaccination Among Adults in the United States, 2018–2019

Objectives. To provide adjusted rates of self-reported receipt of the influenza vaccine in the 2018-2019 flu season among adults in large metropolitan, medium and small metropolitan, and nonmetropolitan areas of the United States by age group, gender, and race. Methods. We queried the 2019 National Health Interview Survey for respondents aged 18 years and older. To provide national estimates of influenza vaccination coverage, we performed sample-weighted multivariable logistic regressions and predicted marginal modeling while adjusting for age, gender, race/ethnicity, and urban-rural household designation. Results. After weighting, 48.1%, 46.2%, and 43.6% of adults from large metropolitan, small and medium metropolitan, and nonmetropolitan areas, respectively, received the influenza vaccine. Additionally, there was a trend toward declining influenza vaccination status from large metropolitan to rural areas in all age groups, both genders, and multiple racial/ethnic groups. Conclusions. Self-reported influenza vaccination rates were lower in rural than in urban areas among adults of all age groups and both genders. Using community leaders for health promotion, augmentation of the community health care workforce, and provision of incentives for providers to integrate influenza vaccination in regular visits may expand influenza vaccine coverage. (Am J Public Health. 2022;112(2):304-307. https://doi.org/10.2105/AJPH.2021.306575).