A National Investigation of Health Equity Considerations in COVID-19 Vaccination in the United States Open Access

Vashist, Kushagra (Spring 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/nz806097j?locale=en


Background: After a half-million American deaths due to COVID-19, three SARS-COV-2 vaccines have been approved for emergency use. To reach herd immunity and control the spread of infection, an overwhelming majority of the population needs to be vaccinated. However, socio-demographic characteristics such as being person of color, having low income, and less educational attainment are expected to be adversely affected by COVID-19 infection and have lower vaccine uptake.

Methods: Using the 2018 National Health Interview Survey, we first described the distribution of non-institutionalized populations prioritized for COVID-19 by race and ethnicity, age, sex and region as per the Advisory Committee for Immunization Practices framework. Secondly, we identified socio-demographic groups that may be at risk for lower uptake of adult vaccinations by examining the differences in likelihood of getting flu vaccine by commonly identified priority groups for the remainder of the roll-out.


Results: We found that approximately 85% of US adults fall into Phase 1 and 15% fall into Phase 2 of the vaccine priority schedule. Phase 1 had a similar demographic composition relative to the US population. Phase 2 had greater share of men, younger adults and Hispanics. When examining prior flu vaccine receipt among COVID-19 vaccine priority groups, we found that the relative odds of receiving flu vaccine were significantly lower in medically vulnerable adults (aOR=0.43, 95% CI= 0.37, 0.48), essential workers (aOR=0.28, 95% CI= 0.23, 0.34), and the general population (aOR=0.32, 95% CI= 0.28, 0.37) compared to healthcare workers in the fully adjusted model. Factors associated with lower uptake included being young, male, of Black race, a current smoker, having no health insurance, less education, income lower than $100,000, and not researching health related information on the internet.


Conclusion: Our study highlights demographic groups at risk for lower COVID-19 vaccine uptake to guide the development of tailored strategies to increase equitable vaccine coverage. The medically vulnerable, non-healthcare essential workers, and general population have been less likely to get adult vaccines compared to healthcare workers. Being Black, young, male, less educated, earning less than $100,000, and having no health insurance were all associated with lower flu vaccine uptake.


Table of Contents

Table of Contents

Introduction. 1

Literature review.. 4

Manuscript 1. 9

Background. 10

Objective. 10

Methods. 10

Results. 11

Discussion. 11

Limitations. 12

Table. Distribution of the non-institutionalized adult COVID-19 vaccination priority populations by sex, race/ethnicity, age and region. 14

Supplemental Information. 16

Manuscript 2. 19

Abstract 20

Introduction. 21

Methods. 22

Results. 24

Discussion. 26

Public Health Implications. 29

Tables and Figures. 30

Table 1. Demographic composition of US adults overall and classified by COVID-19 vaccination priority groups, NHIS 2018. 30

Table 2. Logistic regression examining unadjusted and adjusted associations between flu vaccine uptake and priority groups, and socio-economic and health-related factors, NHIS 2018. 32

Figure 1. Prior flu vaccine uptake by COVID-19 vaccination priority group, NHIS 2018. 34

Supplemental Information. 35

Conclusions. 38

References. 39

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