Although this was a large increase over the 34 percent coverage rate reported in 1995, the 1997 national average fell far below the Healthy People 2000 goal of 60 percent coverage, and this goal has still not been met. According to BRFSS, only 17 states had achieved immunization rates of 50 percent or greater among the elderly by 1997. Coverage in 1997 ranged from 9.5 percent (New York) to 30.7 percent (Alaska) among persons aged 55–64, with a median of 17.1 percent. For persons aged 65–74, percentages ranged from 30.1 percent (New Jersey) to 56.9 percent (Arizona), with a median of 42.6 percent. Finally, for persons over age 75, the percentages ranged from 31.4 percent (Louisiana) to 79 percent (Nevada), with a median of 53.3 percent (Janes et al., 1999).

Although differences in coverage rates among children of different ethnic groups have been significantly reduced, troublesome disparities remain in adult immunization coverage levels (see Table 3–6). According to 1997 NHIS data, elderly blacks had the lowest likelihood of receiving either influenza (45 percent) or pneumococcal (22 percent) immunizations. Elderly Hispanics had influenza and pneumococcal immunization coverage levels of 53 percent and 23 percent, respectively, as compared with coverage levels of 66 percent and 46 percent, respectively, for whites in 1997.

Noninstitutionalized high-risk adults aged 18–64 have extremely low immunization rates and may present the largest challenge to efforts to appropriately immunize adults (see Table 3–6). The 1997 NHIS data demonstrate that only 26 percent of this group had received an influenza vaccination, while only 13 percent had received a pneumococcal vaccination. Differences in coverage levels among races were not as great in the high-risk population aged 18–64 as in the population over age 65. Compared with the elderly, the high-risk group aged 18–64 had very low rates of immunization coverage. In 1997, among those with private health insurance, 29 percent of high-risk adults aged 18–64 and 63 percent of the noninstitutionalized elderly received an influenza vaccination. Among those with Medicaid, 26 percent of the high-risk population aged 18–64 received an influenza vaccination (see Table 3–6) (National Center for Health Statistics, 1997).

The 1997 NHIS also provides information on selected high-risk sub-groups. Coverage rates for the noninstitutionalized elderly were higher than those for the high-risk population aged 18–64 in every subgroup. In 1997, 67 percent and 44 percent, respectively, of noninstitutionalized elderly with diabetes received influenza and pneumococcal vaccinations. In contrast, only 36 percent and 19 percent, respectively, of adults aged 18– 64 with diabetes received influenza and pneumococcal vaccinations. Data on national coverage rates for adult immunizations other than influenza and pneumococcal are severely limited. According to Healthy People

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