Association Between Racial Segregation and COVID-19 Vaccination Rates

Abstract

Objective: To examine the association between county-level Black-White residential segregation and COVID-19 vaccination rates. Design: Observational cross-sectional study using multivariable generalized linear models with state fixed effects to estimate the average marginal effects of segregation on vaccination rates. Setting: National analysis of county-level vaccination rates. Main Outcome Measure: County-level vaccination rates across the United States. Results: We found an overall positive association between county-level segregation and the proportion population fully vaccinated, with a 6.8, 11.3, and 12.8 percentage point increase in the proportion fully vaccinated by May 3, September 27, and December 6, 2021, respectively. Effects were muted after adjustment for sociodemographic variables. Furthermore, in analyses including an interaction term between the county proportion of Black residents and the county dissimilarity index, the association between segregation and vaccination is positive in counties with a lower proportion of Black residents (ie, 5%) but negative in counties with the highest proportions of Black residents (ie, 70%). Conclusions: Findings highlight the importance of methodological decisions when modeling disparities in COVID-19 vaccinations. Researchers should consider mediating and moderating factors and examine interaction effects and stratified analyses taking racial group distributions into account. Results can inform policies around the prioritization of vaccine distribution and outreach.

Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study

“…Our findings add value to the existing literature by reinforcing the validity of county-level residential segregation as an indicator of racial and ethnic disparities. The negative impact of residential segregation on COVID-19 booster coverage was consistent with the empirical findings [17][18][19]. Racial and ethnic minority communities often experienced a scarcity of vaccine distribution sites and vaccine doses, resulting in low vaccination rates in these areas [17].…”

“…Defined as the relative amount of physical space occupied by the Black population, the residential segregation in this study had consistent distributions with data from the National Institute on Minority Health and Health Disparities, demonstrating the validity of our residential segregation index [33]. There are more and more research conducted at the population level that examine the association of residential segregation with health outcomes [18,19]. Our findings add value to the existing literature by reinforcing the validity of county-level residential segregation as an indicator of racial and ethnic disparities.…”

“…One of the major barriers is residential segregation that restricts access to health care resources in minority communities [17]. Empirical research demonstrated that more segregated counties had more pronounced differences in COVID-19 vaccine coverage between Black and White residents [18,19]. However, the vast majority of evidence regarding racial and ethnic disparities in COVID-19 vaccination was generated from the studies at the individual level with limited population-level analyses.…”

“…However, the vast majority of evidence regarding racial and ethnic disparities in COVID-19 vaccination was generated from the studies at the individual level with limited population-level analyses. Of the few population-based studies, most were cross-sectional designs and did not examine the difference in COVID-19 vaccination by age groups [18,19]. Knowledge gleaned from these age-specific disparities can illuminate the progress of vaccination in racial and ethnic minority communities and facilitate the process of health care policy-making.…”