Poorer US counties have lower COVID-19 vaccine uptake

NJ vaccine center
NJ vaccine center


A study yesterday in Vaccine reveals socioeconomic disparities in county-level COVID-19 vaccine uptake, with a 32% lower vaccination rate in the most disadvantaged areas.

In the study, researchers from the University of Arkansas for Medical Sciences in Little Rock used the COVID-19 Community Vulnerability Index (CCVI) and seven theme scores to identify links between socioeconomic vulnerability and adult vaccination rates in 2,415 counties up to May 25, 2021.

To track vaccination rates, they used the Centers for Disease Control and Prevention COVID Data Tracker. Two age-groups were considered: 18 years and older and 65 and older.

The overall vaccination rate was 48.2%, with county-level uptake of 1.0% to 84.7% (10th to 90th percentile, 33.6% to 48.2%). County-level rates in states with at least 10 represented counties ranged from 42.9% to 55.9% in New Hampshire to 1.0% to 63.7% in Massachusetts. In all states except five, the vaccination rate in the county with the highest vaccine uptake was more than double that of the county with the lowest rate.

State-level vaccination rates, the researchers said, varied almost two-fold. For example, 53% of Vermont residents were fully vaccinated as of May 25, versus only 27% of Mississippi residents.

The southern United States had the most high-vulnerability counties with low vaccination rates, with more than half of the counties in 10 states having this status: Alabama (92.5%), Mississippi (82.9%), Louisiana (81.3%), Tennessee (80.0%), South Carolina (71.7%), Florida (59.7%), North Carolina (69.0%), Oklahoma (61.0%), Arkansas (58.7%), and Kentucky (51.7%). 

Lower uptake in counties with more Black residents

COVID-19 vaccination rates were 5% higher in less-vulnerable counties than in the most vulnerable counties (46.5% vs 44.4%). The difference in vaccination uptake for all themes in both age-groups—apart from the high-risk environment theme—was significant.

Theme 3, which consists of household type and composition, transportation, and disability, was tied to the largest vaccination gap (32%), with 40.2% vaccination rates in residents in the most-disadvantaged counties, compared with 53.1% in the least.

The researchers showed that a 10-point rise in the CCVI, low socioeconomic status, housing type and composition, and epidemiologic factors were tied to a 1.0 percentage point or more reduction in county-level vaccination uptake. Vaccination rate differences were also tied to racial minority status and language and population density for both age-groups.

A post hoc assessment showed high vaccination rates in 89% of counties in which Asian populations made up the largest proportion of the minority population. Results were similar for Hispanic (52%), and American Indian/Alaska Native (44%) populations, in contrast to counties in which Black residents made up the largest proportion of minorities, at 32%.

Prioritized vaccine allocation, outreach

The researchers noted that previous studies have found that marginalized areas have individual- and community-level factors that increase the risk of COVID-19 exposure, such as multifamily or multigenerational households and employment in conditions with inadequate protection from the coronavirus. Residents in these areas also tend to have less access to healthcare, lack health insurance, and have more underlying medical conditions, all of which predispose them to poor COVID-19 outcomes.

The authors also pointed out that uninsured or low-income residents may see their healthcare providers less, not understand that vaccines are free, and have less access to the technology needed to gather vaccine information and make an appointment.

"Continued efforts to provide outreach to marginalized communities, including mobile vaccination clinics and scheduling and educational resources using multiple modalities, may improve equity in vaccination," the authors concluded. "A prioritization approach should be considered to increase vaccine allocation and educational outreach among areas with higher levels of vulnerability."

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