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

Abstract

AbstractBackgroundTo date, there has been limited data available to understand the associations between race/ethnicity and socioeconomic and related characteristics with novel coronavirus disease (COVID-19) vaccine initiation and planned vaccination in the United States.MethodsTo better characterize COVID-19 vaccinations nationally, we leveraged large cross-sectional surveys conducted between January and March 2021 with relatively complete race/ethnicity and socioeconomic data and nationally-representative of U.S. households to estimate trends in levels of COVID-19 vaccine initiation and vaccine intention. We further used survey data from January and March 2021 in adults aged 18-85 years to analyze the associations between race/ethnicity, education, pre-pandemic household income, and financial hardship during the pandemic and the adjusted odds of: 1) receipt of ≥1 dose of a COVID-19 vaccine; and 2) among those unvaccinated, the definite intention to receive a vaccine, controlling for other demographic and socioeconomic factors.ResultsWe observed persistent disparities in vaccine initiation for non-Hispanic Blacks, Hispanics, and non-Hispanic multiracial persons, and in vaccine intention for Blacks and multiracial persons, compared to non-Hispanic Whites and non-Hispanic Asians. In late March 2021, the prevalence estimates of Hispanics and Blacks receiving a vaccine were 12 percentage points and 8 percentage points lower than for Whites, respectively. Moreover, both education and income levels exhibited positive dose-response relationships with vaccine initiation (P for trend≤01 and <.001, respectively). Substantial financial hardship was linked to 35-44% lower odds of vaccination (P<.001). The most common reasons for vaccine hesitancy were concerns about side effects and safety, with evidence of higher levels of concerns about vaccine safety among Blacks vs. Whites.ConclusionsIn 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 the persevering racial/ethnic and socioeconomic inequities in vaccination due to differential access and vaccine hesitancy is essential to mitigate the pandemic’s higher risks of infection and adverse health outcomes in Hispanic, Black, and socioeconomically-disadvantaged communities.