Associations of Race/Ethnicity and Other Demographic and Socioeconomic Factors with Vaccination During the COVID-19 Pandemic in the United States

Kim, D.

BACKGROUND. To date, there has been limited data available to understand the associations between race/ethnicity and socioeconomic and related characteristics with COVID-19 vaccine initiation and planned vaccination in the United States. To better characterize COVID-19 vaccinations nationally, the present study leveraged nationally-representative data with relatively complete race/ethnicity and socioeconomic data to estimate levels of vaccine initiation and the adjusted relative odds of vaccine initiation and planned vaccination among adults by race/ethnicity and socioeconomic and other characteristics. METHODS. Using pooled cross-sectional data from 66,994 adults aged 18-85 years in nationally-representative surveys by the U.S. Census Bureau administered between January 6, 2021 and January 18, 2021 and multivariable logistic regression, this study estimated the associations between race/ethnicity, education, and pre-pandemic (2019) household income with the self-reported: 1) receipt of [≥]1 dose of a COVID-19 vaccine; and 2) either receipt of [≥]1 dose of a COVID-19 vaccine or the plan to definitely receive a vaccine once available to the respondent. RESULTS. In Hispanics and Black non-Hispanics, the estimated prevalences of vaccine initiation were 6.1% and 6.2%, respectively, compared to 8.7% in White non-Hispanics and 15.1% in Asian non-Hispanics. Controlling for demographic and socioeconomic factors, Hispanics and Black non-Hispanics were no more or less likely than White non-Hispanics to have received [≥]1 vaccine dose. However, for the combined outcome of either vaccine initiation or planned vaccination, Black non-Hispanics were 52% less likely than White non-Hispanics to have reported either outcome (P<.001). Meanwhile, both education and pre-pandemic income levels exhibited evidence of positive dose-response relationships with vaccine initiation (P for linear trend = .01 and <.001, respectively). Substantial (vs. no) financial hardship was linked to 44% lower odds of vaccination (P<.001). The most common reasons for vaccine hesitancy were concerns about side effects and safety. CONCLUSIONS. In this large, nationally-representative study with relatively complete race/ethnicity and socioeconomic data, we find that being Black non-Hispanic and having the least education and income were each independently associated with a markedly lower likelihood of definitely planning to get vaccinated or having been vaccinated. In the ensuing months of the pandemic, addressing racial/ethnic and socioeconomic inequities in vaccination due to differential access and vaccine hesitancy will be critical to mitigate the pandemic's disproportionately higher risks of infection and adverse outcomes in Black non-Hispanics and socioeconomically disadvantaged groups and to help maximize vaccination coverage nationwide.