# Coverage of the influenza and pneumococcal vaccinations among immigrant and non-immigrant older adults in Canada: a cross-sectional analysis of data from the Canadian Longitudinal Study on Aging (CLSA)

## TL;DR

Older immigrant adults in Canada have lower rates of influenza and pneumococcal vaccinations compared to non-immigrant older adults.

## Contribution

This study identifies disparities in vaccination coverage by immigrant status in Canadian older adults using national data.

## Key findings

- Immigrant participants had lower influenza vaccination coverage (63.8%) compared to non-immigrants (66.9%).
- Pneumococcal vaccination coverage was also lower among immigrants (48.7%) than non-immigrants (55.8%).
- Immigrant status was a top predictor for pneumococcal vaccination but less important for influenza vaccination.

## Abstract

Influenza and pneumococcal vaccination coverage in older adults fall below the target of 80%. Being an immigrant may be associated with lower coverage of both vaccinations, but limited efforts have been made in the Canadian context to explore such disparities. Therefore, we examined the association between immigrant status and coverage of influenza and pneumococcal vaccinations among older adults as well as the relative importance of immigrant status in predicting coverage of both vaccinations.

We conducted a cross-sectional secondary analysis of the Canadian Longitudinal Study on Aging data. We descriptively analyzed coverage of both vaccinations by immigrant status and used Poisson regression models with robust standard errors to estimate the associations of immigrant status and other key equity stratifiers with vaccination. Importance of various determinants, including immigrant status, in predicting both vaccinations were assessed using random forest algorithms.

Immigrant participants reported lower coverage of influenza vaccination in the past 12 months (63.8% [95% CI: 60.9–66.7%] vs. 66.9% [95% CI: 65.5–68.3%]) and pneumococcal vaccination ever (48.7% [95% CI: 45.6–51.8%] vs. 55.8% [95% CI: 54.3–57.3%]). Prevalence of influenza and pneumococcal vaccinations were both lower among immigrant participants compared to non-immigrant participants. Immigrant status was among the 10 most important predictors of pneumococcal vaccination, but among the less important predictors of influenza vaccination.

Overall, we found disparities in influenza and pneumococcal vaccination by immigrant status among older adults in Canada. Further studies on vaccination coverage and decision-making among marginalized communities, including immigrants, are warranted to equitably improve vaccine uptake.

The online version contains supplementary material available at 10.1186/s12889-025-25005-z.