Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–January 31, 2022

Saelee, Ryan; Zell, Elizabeth R.; Murthy, Bhavini Patel; Castro-Roman, Patricia; Fast, Hannah E; Meng, Lu; Shaw, Lauren; Gibbs‐Scharf, Lynn; Chorba, Terence; Harris, LaTreace; Murthy, Neil

doi:10.15585/mmwr.mm7109a2

Cited by 124 publications

(89 citation statements)

References 4 publications

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“…Individuals aged 18-49 years had the lowest prevalence of vaccination, likely highlighting increased hesitancy and perception that COVID-19 is not serious given the lower mortality risk among younger persons, agreeing with findings among childcare providers. 38 Rural residents were less likely to be vaccinated than urban residents, concurring with published findings, 12,39 with the largest disparity observed in the Southwest, and the smallest in the Southeast and Midwest. Uninsured individuals had higher prevalence of nonvaccination than insured persons; this disparity is consistent with routine adult vaccinations, 40 although COVID-19 vaccines are available at no-cost.…”

Section: Discussionsupporting

confidence: 84%

“…7 Despite high national vaccination coverage, spatial heterogeneity in vaccination can contribute to outbreaks in areas with high numbers of unvaccinated individuals. 8,9 Analyses of disparities in vaccination coverage show variability by socioeconomic and sociodemographic factors, including reduced vaccination coverage among younger persons, 10 residents of rural counties, [10][11][12] and residents of counties with higher social vulnerability. 10,13,14 Many of these groups (i.e., those living in rural areas, with lower household income, less education, and Black and Hispanic persons) have greater vaccine hesitancy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Geographic Heterogeneity in Behavioral and Social Drivers of COVID-19 Vaccination

Masters

Zhou²,

Meng³

et al. 2022

American Journal of Preventive Medicine

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Geographic Heterogeneity in Behavioral and Social Drivers of COVID-19 Vaccination

Masters

Zhou²,

Meng³

et al. 2022

American Journal of Preventive Medicine

Self Cite

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“…Lower SVI scores indicate that an area is less socially vulnerable. Previous research found that COVID-19 vaccine coverage was lower in rural counties than in urban counties (31). Residents of communities within more socially vulnerable areas may have more barriers to accessing vaccination providers, including limited transportation options, higher disability, and reduced ability to seek out or engage with vaccine providers (32,33).…”

Section: Discussionmentioning

confidence: 98%

Factors Associated with Delayed or Missed Second-Dose mRNA COVID-19 Vaccination among Persons >12 Years of Age, United States

Meng¹,

Murthy²,

Murthy³

et al. 2022

Emerg. Infect. Dis.

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I n December 2020, the US Food and Drug Administration (FDA) issued Emergency Use Authorizations (EUAs) for the Pfizer BioNTech (https://www. pfizer.com) and Moderna (https://www.modernatx. com) 2-dose primary mRNA COVID-19 vaccine series (1,2). The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices, part of the National Center for Immunization and Respiratory Diseases, prioritized certain populations to be offered the COVID-19 vaccination first, including healthcare personnel, long-term care facility residents, persons >65 years of age, persons 16-64 years of age with high-risk medical conditions, and essential workers (3). Starting in March 2021, Pfizer-BioNTech and Moderna COVID-19 vaccines have been available at pharmacies and from other medical practice providers for anyone >16 years of age. In the 1-year period of this analysis, the recommended intervals between the 2 primary doses were 21 days for the Pfizer-BioNTech vaccine and 28 days for the Moderna vaccine (4). On May 10, 2021, FDA expanded the EUA for the Pfizer COVID-19 vaccine to include persons 12-15 years of age (5). During August-November 2021, FDA approved a series of EUAs: 1 for an additional primary dose for immunocompromised persons and 1 for a booster dose for persons >18 years of age (6).In the summer of 2021, one of every 10 US persons received the first dose of an mRNA COVID-19 vaccine, ≈15 million still had not received the second dose, and many more had received the second dose outside the recommended intervals between doses (7). Persons who start the primary series are presumably amenable to initial vaccination but may then either delay completing or may fail to complete the series. Delayed or missed recommended COVID-19 vaccine doses can hamper national efforts to reduce COVID-19-associated illness, hospitalization, and death (8-10). More information about this population is valuable for addressing second-dose vaccination

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“…In the Southeast, Southwest, Rocky Mountain, and Plains regions, there was a rural mortality disadvantage in 2020, which was exacerbated in 2021. This suggests that the pandemic has impacted rural areas heavily, especially in 2021, suggesting a need for increased preventative measures in these areas where vaccination remains low (31).…”

Section: Discussionmentioning

confidence: 99%

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

Paglino¹,

Lundberg²,

Cho³

et al. 2022

Preprint

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Official Covid-19 death tallies have underestimated the mortality impact of the Covid-19 pandemic in the United States. Excess mortality, which compares observed deaths to deaths expected in the absence of the pandemic, is a useful measure for assessing the total effect of the pandemic on mortality levels. In the present study, we produce county-level estimates of excess mortality for 3,127 counties between March 2020 and December 2021. We fit two hierarchical linear models to county-level death rates from January 2015 to December 2019 and predict expected deaths for each month during the pandemic. We compare these estimates with the observed numbers of deaths to obtain excess deaths for each county-month. An estimated 936,911 excess deaths occurred during 2020 and 2021, of which 171,168 were not assigned to Covid-19 on death certificates. Urban counties in the Far West, Great Lakes, Mideast, and New England experienced a substantial urban mortality disadvantage in 2020, whereas rural counties in these regions had higher mortality in 2021. In the Southeast, Southwest, Rocky Mountain, and Plains regions, there was a rural mortality disadvantage in 2020, which was exacerbated in 2021. The proportion of excess deaths assigned to Covid-19 was lower in 2020 (76.3%) than in 2021 (87.0%), suggesting fewer Covid-19 deaths went unassigned later in the pandemic. However, in rural areas and in the Southeast and Southwest a large share of excess deaths were still not assigned to Covid-19 during 2021.

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Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–January 31, 2022

Cited by 124 publications

References 4 publications

Geographic Heterogeneity in Behavioral and Social Drivers of COVID-19 Vaccination

Geographic Heterogeneity in Behavioral and Social Drivers of COVID-19 Vaccination

Factors Associated with Delayed or Missed Second-Dose mRNA COVID-19 Vaccination among Persons >12 Years of Age, United States

Monthly excess mortality across counties in the United States during the Covid-19 pandemic, March 2020 to February 2022

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