OBJECTIVE: To identify factors associated with receipt of the pneumococcal and influenza vaccines among community-dwelling older persons with chronic disease. METHODS: A population-based sample of urban and rural Iowa adults age 65 years and older with one or more self-reported target medical conditions were interviewed by telephone. Information was obtained on aspects of health care access, which were examined as potential determinants of receipt of recommended vaccines. RESULTS: A total of 787 interviews were completed (response rate = 68%; completion rate for screened, eligible subjects = 91%). Two-thirds (n = 531, 68%) reported influenza vaccination in the last year, and one-half (51%, n = 393) reported ever receiving the pneumococcal vaccine. Both vaccines were received at recommended intervals by 347 subjects (44%). Multivariable logistic regression identified the following factors independently associated with receipt of both vaccines: age 70 or greater (OR = 1.64, CI95 = 1.15, 2.32); married (OR = 1.41, CI95 = 1.03, 1.92); self-owned residence (OR = 0.57, CI95 = 0.33, 0.97); working (OR = 2.94, CI95 = 1.38, 6.18); increased number of target medical conditions (OR = 1.3 for each, CI95 = 1.09, 1.54); current prescription medication (OR = 2.04, CI95 = 1.32, 3.14); and a physician visit in the last year (OR = 2.53, CI95 = 1.52-4.19). Receipt of the vaccines was unrelated to geographic location in a rural area. CONCLUSIONS: Despite their proven safety and efficacy, many persons with at least two indications to receive either vaccine remain unvaccinated. Among the elderly with chronic disease, predisposing and need factors were independently associated with receipt of both vaccines. Enabling factors assessed appeared less important in this population. Targeting of the elderly and those with chronic disease to receive recommended vaccines is needed to adequately protect these populations at risk.