Exploring Immigrant Disparities: The Influence of Immigrant Status on COVID-19 Vaccination in the United States Public

Abstract

Background:

In the United States, despite the substantial number of immigrants, detailed research into

their health outcomes is limited. The COVID-19 pandemic has further amplified health

disparities among this group. Studies often combine diverse immigrant groups: refugees,

migrants, naturalized, and undocumented individuals into a single category of 'immigrants',

failing to acknowledge the unique challenges and disparities each subgroup faces. Our study

seeks to address these gaps by analyzing the 2022 California Health Interview Survey (CHIS) to

discover the effects of immigration status on COVID-19 vaccination rates. We expand our

research beyond commonly studied variables like language and culture, to obtain a further

comprehensive understanding of vaccine decision.

Method:

Secondary data analysis was conducted from the CHIS adult sample. 21,463 individuals

were categorized into three groups: US-born (n =15,866), naturalized (n=3,993), and non-US

citizens (n=1,604). The polytomous logistic regression was applied to evaluate and control

demographic and risk-reduction behavioral characteristics.

Result:

Among 21,463 individuals, 93.5% of naturalized citizens, 88.7% of non-US citizens, and

89.5% of US-born citizens were fully vaccinated. Logistic regression revealed that naturalized

citizens were 1.41 times more likely to be vaccinated compared to US-born citizens (aOR: 1.41;

CI: 1.19-1.67) with demographic adjustment. Controlling for behavioral factors, naturalized

citizens were 51% more likely to vaccinate (CI: 1.31 – 1.74) and 37% more likely (aOR: 1.37;

CI: 1.15-1.64) with controlling for all variables. Non-US citizens exhibited varying likelihoods

with no statistical significance. A positive correlation was found between increasing age and

vaccination likelihood, with oldest age twice more likely to vaccinate (aOR:2.08; CI:1.54-2.82).

Decreased English proficiency reduced vaccination likelihood, with ratios ranging from 1.05 to

0.60 as proficiency levels declined. Risk-reduction behaviors was associated with a greater

likelihood of vaccination.

Conclusion:

This preliminary study is one of the few that analyzes COVID-19 vaccination behaviors

across immigrant subgroups, providing comprehensive insights into the complex dynamics that

shape vaccination. This study highlights the need for public health research to address the unique

barriers tailored specifically to this diverse community. Developing interventions that cater

specifically to different immigrant subgroups is essential for bridging healthcare gaps and

promoting health equity.

Table of Contents

Chapter 1: Introduction ................................................................................................................1

Chapter 2: Literature Review.......................................................................................................5

2.1 Classification and Diversity of Immigrant Population .......................................................................5

2.2 Significance of Vaccination ...............................................................................................................6

2.2.1 Vaccines in General ..............................................................................................................6

2.2.2 COVID-19 Vaccines ............................................................................................................7

2.3 COVID-19 Vaccination Rate ..............................................................................................................8

2.4 COVID-19 Vaccination among Immigrants in the US ....................................................................10

Chapter 3: Methods .....................................................................................................................11

3.1 Data Source and Study Population ...................................................................................................11

3.2 Definitions and Measures .................................................................................................................12

3.3 Statistical Analysis ..........................................................................................................................14

Chapter 4: Result ........................................................................................................................15

4.1 Study Population and Characteristics................................................................................................15

4.2 Demographics and Behaviors ...........................................................................................................16

4.3 Threshold and Model Fit Statistics ...................................................................................................19

4.4 Logistic Regression ..........................................................................................................................20

Chapter 5: Discussion ..................................................................................................................27

5.1 Preliminary Findings.........................................................................................................................27

5.1.1 Immigrant Status and Vaccination ...........................................................................................27

5.1.2 Influence of behavior and demographic factors ..........................................................30

5.2 Strengths and Limitations: ................................................................................................................31

5.3 Conclusion ........................................................................................................................................32

References ....................................................................................................................................34

Appendix ......................................................................................................................................48

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Infectious Disease Immigrant Health
Committee Chair / Thesis Advisor	Unjali Gujral, Emory University

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