Cluster analysis reveals 3 main patterns of behavior towards SARS-CoV-2 vaccination in patients with autoimmune and inflammatory diseases

Felten, Renaud; Dubois, Maxime; Ugarte-Gil, Manuel Francisco; Chaudier, Aurore; Kawka, Lou; Bergier, Hugo; Costecalde, Charlotte; Pijnenburg, Luc; Fort, Jérémy; Chatelus, Emmanuel; Sordet, Christelle; Javier, Rose-Marie; Gottenberg, Jacques-Eric; Sibilia, Jean; Fuentes-Silva, Yurilis J; Arnaud, Laurent

INTRODUCTION: Given the COVID19 pandemic, it is crucial to understand the underlying behavioral determinants of SARS-CoV-2 vaccine hesitancy in patients with autoimmune or inflammatory rheumatic diseases AIIRD. We aimed to analyze patterns of behaviors regarding SARS-CoV-2 vaccination in AIIRD patients, as a mean to identify pragmatic actions to increase vaccine coverage in this population. METHODS: Data of 1258 AIIRD patients were analyzed using univariate and multivariate logistic regression models, to identify variables associated independently with the willingness to get vaccinated against SARS-CoV-2. Subsets of patients showing similar behaviors towards SARS-CoV-2 vaccination were characterized using cluster analysis. RESULTS: Hierarchical cluster analysis identified 3 distinct clusters of AIIRD patients. Three predominant patients’ behavior towards SARS-COV-2 vaccination: ‘voluntary’, ‘hesitant’ and ‘suspicious’ were identified. While vaccine willingness was significantly different across the 3 clusters p< 0.0001, there was no difference regarding the fear to get COVID-19 p= 0.11, the presence of co-morbidities p= 0.23, the use of glucocorticoids p= 0.21 or the immunocompromised status p= 0.63. However, patients from cluster #3 ‘suspicious’ were significantly more concerned about vaccination, the use of a new vaccine technology, the lack of hindsight regarding COVID vaccination and potential financial links with pharmaceutical companies p< 0.0001 in all than in the other 2 clusters. DISCUSSION: Importantly, the differences between patients’ behaviors are not related to the fear of getting COVID-19 or to any state of frailty, but point out to specific concerns about vaccination. This study may serve as a basis for improved communication, to increase COVID-19 vaccine coverage in AIIRD patients.