The purpose of this study was to determine the prevalence and factors associated with influenza vaccine nonreceipt among adults in the United States. This nationally representative, cross-sectional study analyzed self-reported data on influenza vaccination status and sociodemographic, physical health, and health care access factors among 27,189 adults from the 2022 National Health Interview Survey. The primary outcome was influenza vaccination nonreceipt in the past 12 months. A multivariable logistic regression model evaluated associations between 19 sociodemographic, physical health, and health care access variables with influenza vaccine nonreceipt. Shapley Additive Explanations assessed the relative importance of covariates associated with nonreceipt in the regression model. The population-weighted analysis indicated 52.8% influenza vaccination nonreceipt among US adults. The logistic regression model identified 15 covariates as significantly associated with vaccine nonreceipt. When evaluating the relative importance of the variables, the key determinants of vaccine nonreceipt were younger age, lack of doctor visits in the past year, and lower educational attainment. Influenza vaccine nonreceipt was 92.4% among adults with all 3 characteristics compared to only 16.0% among those with none of the characteristics. In conclusion, influenza vaccine coverage in the overall US adult population remains well below public health goals. Significant disparities persist among subgroups like younger adults, those without recent health care visits, and individuals with lower educational attainment. There is an urgent need for expanded outreach efforts targeting vulnerable populations to address disparities in vaccine uptake.