Vaccination Inequities Among Foreign-Born Adults in the United States: The Role of Citizenship, Socioeconomic Disadvantage, and Healthcare Access in the 2024 National Health Interview Survey

Foreign-born adults make up a growing and diverse share of the U.S. population. Yet much of what is known about adult vaccination comes from studies conducted before the COVID-19 pandemic. Many focused on a single vaccine or treated immigrants as a single group. We examined influenza, COVID-19, shingles, and pneumococcal vaccination among U.S.-born adults, foreign-born U.S. citizens, and foreign-born noncitizens. We also assessed the extent to which observed differences were attenuated after adjustment for socioeconomic conditions and access to healthcare. Data came from 31,362 adults who participated in the 2024 National Health Interview Survey. We used survey-weighted modified Poisson regression and adjusted sequentially for demographic, socioeconomic, and healthcare access factors. Family income was pooled across ten NCHS imputations. Noncitizens had the lowest unadjusted vaccination prevalence. Influenza vaccination was 32.2% among noncitizens compared with 43.5% among U.S.-born adults. Shingles vaccination rates were 24.3% versus 45.1%, and pneumococcal vaccination rates were 34.5% versus 67.2%. After full adjustment, the influenza difference was no longer evident (adjusted prevalence ratio or aPR 1.07; 95% CI 0.98–1.17). The gap in shingles vaccination narrowed substantially (aPR 0.85; 95% CI 0.71–1.02). In contrast, disparities in pneumococcal vaccination persisted among both noncitizens (aPR 0.70; 95% CI 0.55–0.90) and foreign-born U.S. citizens (aPR 0.85; 95% CI 0.78–0.94). A different pattern emerged for ever receipt of at least one COVID-19 vaccine dose. Both foreign-born groups were more likely than U.S.-born adults to have ever received at least one dose; because this outcome is cumulative receipt since 2020, it does not indicate whether respondents were up to date with current COVID-19 vaccination recommendations. Overall, disparities among foreign-born adults depended on the vaccine being examined. Differences in influenza and shingles vaccination were substantially attenuated after adjustment for socioeconomic and healthcare access characteristics, whereas the pneumococcal difference was not.