US racial minorities who reported having worse healthcare experiences than those of other races were less likely to be vaccinated against COVID-19, according to a Centers for Disease Control and Prevention (CDC)-led study published today in Morbidity and Mortality Weekly Report.
The researchers parsed interview results from 1,154,347 adult respondents to the National Immunization Survey-Adult COVID Module from April 22, 2021, to November 26, 2022.
Black patients report more discrimination
A total of 3.5% of respondents said they had worse healthcare experiences than people of other races due to discrimination, with significantly higher proportions reported by Black (10.7%), American Indian or Alaska Native (7.2%), other race (6.7%), Hispanic (4.5%), Native Hawaiian or other Pacific Islander (NHOPI) (3.9%), and Asian (2.8%) respondents than by their White counterparts (1.6%).
Unadjusted differences in rates of remaining unvaccinated against COVID-19 among participants reporting worse healthcare experiences relative to those not reporting negative experiences were significant overall (5.3 percentage points) and for NHOPI (19.2), White (10.5), other race (5.7), Black (4.6), Asian (4.3), and Hispanic (2.6) adults.
After adjustment, the prevalence differences tied to being unvaccinated were weaker but statistically significant overall (3.2) and for NHOPI (14.6), White (6.1), Black (2.7), Asian, (3.8), and Hispanic (3.0) participants.
The prevalence of unvaccinated participants who said they had no plan to get vaccinated was significantly higher among those who reported worse healthcare experiences than among those who said their experiences were the same as those of other races, with unadjusted prevalence differences of 3.7 overall and 10.6 among NHOPI, 9.8 among White, 6.3 among other race, 3.5 among Black, and 3.0 among Hispanic respondents.
After adjustment, the prevalence differences lessened but were statistically significant overall (2.9) and for White (6.4), other race (4.9), Black (2.6), and Hispanic (3.3) respondents.
Addressing discrimination in healthcare
"Eliminating inequitable experiences in health care settings might help reduce some disparities in receipt of a COVID-19 vaccine," the study authors wrote. "To advance vaccine equity, CDC has funded national, state, local, and community-level partners who work with their communities to increase vaccine access, confidence, demand, and equity by training trusted messengers, setting up vaccination clinics, and conducting community outreach in local languages and dialects."
The researchers called for more data on healthcare discrimination and for prevention programs that could address discrimination as a source of vaccine hesitancy when implementing healthcare strategies.
Eliminating inequitable experiences in health care settings might help reduce some disparities in receipt of a COVID-19 vaccine.
"Health care providers might foster patient trust and improve adherence to recommended health interventions by becoming aware of patients' potential negative health care experiences and of known incidents of historical mistreatment, and incorporating this sensitivity into their patient interactions," they wrote.
"Since the CDC Director's declaration that racism is a serious public health threat, CDC's scientific research to address health inequities rooted in racism has expanded across the agency with a renewed commitment to better understanding both the social determinants of health (including poverty) and the social determinants of equity (including racism) and to addressing the racial and ethnic health inequities revealed throughout the COVID-19 pandemic," they concluded.