For a better experience, click the Compatibility Mode icon above to turn off Compatibility Mode, which is only for viewing older websites.

Stark Racial Disparities in Vaccine Uptake and Flu-related Deaths in Big Cities

In big U.S. cities, flu vaccination rates can vary among racial and ethnic groups.

November 14, 2023

The CDC encourages flu vaccination to prevent flu-related illness among everyone and to reduce flu transmission to those with the highest risk of severe symptoms or death, namely young children and older adults aged 60+. Additionally, flu can spread rapidly in congregate settings common in cities, such as multi-family housing, dormitories, or health facilities, which is why vaccination campaigns particularly target people living or working in those settings.

Using data from the Big Cities Health Inventory, an open-source platform providing health metrics for the 35 large U.S. cities that comprise the Big Cities Health Coalition (BCHC), we investigated flu vaccination rates as well as rates of flu-related deaths among urban residents. 


Platform data from 2021 show that on average only about 50% of older aged residents living in the nation’s largest cities received the flu vaccine. Further, there were stark racial disparities in flu vaccine uptake, a pattern that was seen in all data years. On average only about 30% of older aged Black residents received the flu vaccine and flu-related deaths were highest among Black people compared to other race/ethnic groups (for example, in 2021 per 100,000 age adjusted flu-related death rate was 15.6 for Black people vs 11.3 for white people).

The consistent and stark disparities in flu vaccine rates among Black residents highlight the importance of taking action to increase equity in vaccine uptake and ensure that the high burden of flu-related deaths among Black residents does not persist. In addition to sharing this information, consider these five actions recommended by equity experts:

  1. Assure zero cost of getting the vaccine.
  2. Increase vaccine convenience such as bringing vaccine services to workplaces and community settings.
  3. Offer paid leave so that employees can take time off from work to get the vaccine and recover if they experience short-term side effects.
  4. Design and implement community-based vaccination activities in partnership with trusted community members and influential messengers who share the same ethnic/racial identity.
  5. Listen and empathetically respond to concerns about vaccines and gain residents’ trust.

Learn about CDC’s efforts to promote vaccine equity and BCHC’s policy priorities. To stay up-to-date on the Big Cities Health Inventory please make sure to follow both the Drexel Urban Health Collaborative (@DrexelUHC) and BCHC (@BigCitiesHealth) on Twitter or subscribe to our newsletter.

The Big Cities Health Inventory data platform is primarily funded by the U.S. Centers for Disease Control and Prevention through a cooperative agreement with the National Association of County and City Health Officials. The views expressed on the data platform do not necessarily represent the views of the funders.