Nursing homes in the United States are not meeting the national Medicare and Medicaid goal for flu shots—specifically, African-American nursing home residents are significantly less likely to receive a flu shot, even when compared with white residents living in the same facility, according to a new study published in the journal Health Affairs and reported by a Brown University press release.

For the study, Brown University researchers examined hundreds of thousands of annual patient records from more than 14,000 nursing homes during three flu seasons (2006 to 2007, 2007 to 2008 and 2008 to 2009). For each flu season, scientists determined the overall national vaccination rate and differences in the number of black and white nursing home residents given flu shots.

Findings showed the 2008 to 2009 flu vaccination rate for nursing home residents was nearly 83 percent, which is slightly better than the previous year but still below the 90 percent goal set by Medicare and Medicaid. Researchers noted that while white nursing home residents were vaccinated above the national rate during that season, black residents were 23 percent less likely to receive a flu shot. What’s more, black nursing home residents were 15 percent less likely to be vaccinated than their white neighbors within the same facility.

“One reason you would potentially see a difference is that blacks and whites are by and large served by different nursing homes—and there’s lots of evidence to suggest that blacks are served in nursing homes that are not as good,” explained Vincent Mor, PhD, MEd, professor of health services policy and practices at Brown University, and the study’s senior author. “However, we also see a pretty persistent difference within the same homes, although it is not as large and it has lessened over time.”

Researchers also determined that one of the reasons black nursing home residents get vaccinated less is because they’re more likely to refuse flu vaccination offers than white residents. In fact, the 2008 to 2009 data showed more black residents did in fact refuse vaccinations—nearly 13 percent of blacks compared with almost 9 percent of whites.

But the refusal rates still did not fully account for vaccination disparities, researchers said. They added that more research is needed to see whether the refusals are connected with how the vaccine is offered. Such information could help facilities address their patients’ reluctance and refusal.

If you’re still unsure about getting a flu shot, click here and listen to these athletes’ stories.