Methods: The study included 44,871 US adult participants in the 2012-2015 NHIS who traveled to countries where HAV is endemic. The main outcome was self-reported HAV vaccination (≥ 2 doses). Complex survey methods were applied to all models to provide statistical estimates that are representative of US adults. Multivariable logistic regression models adjusting for covariates were fit to examine the association between nativity, race, race-by-nativity (for interaction) and vaccination status.
Results: For adult travelers to HRCs, the prevalence of HAV vaccination among foreign-born adults was lower than all adults 13.05% (95% CI; 12.11%, 14.00%) vs. 16.12% (95% CI; 15.60%, 16.64%). The adjusted odds ratio (AOR) of HAV vaccination was lower for foreign-born adults compared to US-born AOR 0.86 (95% CI; 0.76, 0.98). For Hispanics, the AOR of HAV vaccination was 0.80 (95% CI; 0.70, 0.91) as compared to non-Hispanic-Whites. Furthermore, a significant qualitative interaction between nativity and race was found (P-value <0.05). Among non-Hispanic Blacks, the adjusted odds of HAV vaccination for foreign-born adults were 1.35 (95% CI; 1.06, 1.72) times the odds for US-born adults. In contrast, the AORs of vaccination of foreign-born versus US-born adults were 36% (95% CI; 17%, 51%) and 30% (95% CI; 12%, 44%), lower for Asians and Hispanics, respectively.
Conclusion: The association between nativity and HAV vaccination status differs by race among travelers to HRCs, with US-born non-Hispanic Black and foreign-born Asian and Hispanic adults having lower vaccination odds. Health care resources should be focused on these target populations to improve travel vaccination compliance. Nativity and race should be both assessed when analyzing and reporting HAV vaccination statistics for adult travelers.
R. NeMoyer, None
N. Trivedi, None
U. Zeb, None
V. Rustgi, Genfit: Grant Investigator and Investigator , Research support . Gilead: Speaker's Bureau , Speaker honorarium . Abbvie: Speaker's Bureau , Speaker honorarium .