Intersectional Inequities in Influenza Vaccination Among New York State Adults, 2024.

Abstract

Objectives. To quantify inequities in influenza vaccination uptake across intersectional strata defined by age, race/ethnicity, gender, and sexual orientation among New York State (NYS) adults. Methods. I analyzed an unweighted sample of 36 236 adults from the 2024 NYS Behavioral Risk Factor Surveillance System using intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. Two-level logistic regression nested individuals in 116 intersectional strata defined by age, race/ethnicity, gender, and sexual orientation. Estimates characterize the analytic sample rather than the NYS adult population. Results. Overall, 46.0% of adults reported having received an influenza vaccination in the past 12 months. Between-stratum differences accounted for 9.6% of total variation in vaccination status. Additive main effects of 4 social dimensions explained 96.4% of this between-stratum variation. Predicted probabilities of vaccination ranged from 21.7% among Hispanic heterosexual males aged 18 to 49 years to 77.2% among non-Hispanic White lesbian females aged 65 years or older. Conclusions. Influenza vaccination inequities in NYS are patterned by multiple social positions. Universal vaccination strategies should be complemented by targeted interventions addressing barriers faced by the intersectional groups with the lowest vaccination uptake, particularly young males from racial/ethnic minority groups. (Am J Public Health. Published online ahead of print October 1, 2026:e1-e8. https://doi.org/10.2105/AJPH.2026.308755).