Racial/Ethnic Variation in Veterans Health Administration COVID-19 Vaccine Uptake

Haderlein, Taona P.; Wong, Michelle S.; Jones, Kenneth T.; Moy, Ernest M.; Yuan, Anita; Washington, Donna L.

INTRODUCTION: Equitable coronavirus disease 2019 (COVID-19) vaccine access is imperative to addressing disproportionate negative impacts of COVID-19 among racial/ethnic minorities. U.S. racial/ethnic minorities have lower COVID-19 vaccination rates than Whites despite higher COVID-19 death/case rates. The Veterans Health Administration (VA) COVID-19 vaccine rollout provides the unique context of a managed care system with few access barriers. This study aims to evaluate race/ethnicity as a predictor of VA COVID-19 vaccination. METHODS: The cohort comprised Veteran VA outpatient users aged ≥65 years (N=3,474,874). COVID-19 vaccination was assessed between December 14, 2020 and February 23, 2021 via procedure codes. Multivariable logistic regressions clustered by VA facility were conducted, controlling for demographics, medical comorbidity, and influenza vaccination history. Based on reports of high COVID-19 vaccine uptake among American Indian/Alaska Natives (AI/ANs), proximity to Indian Health Service Contract Health Service Delivery Areas was tested as a moderating variable. Data analyses were conducted during 2021. RESULTS: Blacks (OR=1.28, 95% CI=1.17, 1.40), Hispanics (OR=1.15, 95% CI=1.05, 1.25), and Asians (OR=1.21, 95% CI=1.02, 1.43) were more likely than Whites to receive VA COVID-19 vaccinations. AI/ANs were less likely than Whites to receive VA COVID-19 vaccinations, but only those residing in Contract Health Service Delivery Area counties (OR= 0.58, 95% CI= 0.47, 0.72). Influenza vaccine history positively predicted COVID-19 vaccine uptake (OR= 2.28, 95% CI=2.22, 2.34). CONCLUSIONS: In the VA, compared with the general U.S. population, COVID-19 vaccine receipt is higher among most racial/ethnic minority groups than Whites, suggesting reduced vaccination barriers compared with non-VA care. The Indian Health Service may provide a safety net effective at reaching AI/AN populations. Addressing vaccination access barriers in non-VA settings can potentially reduce racial/ethnic disparities.