Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–April 10, 2021

Murthy, Bhavini Patel; Sterrett, Natalie; Weller, Daniel; Zell, Elizabeth R.; Reynolds, Laura; Toblin, Robin L.; Murthy, Neil; Kriss, Jennifer L.; Rose, Charles E.; Cadwell, Betsy L.; Wang, Alice; Ritchey, Matthew D.; Gibbs‐Scharf, Lynn; Qualters, Judith R.; Shaw, Lauren; Brookmeyer, Kathryn A.; Clayton, Heather B.; Eke, Paul I.; Adams, Laura; Zajac, Julie; Patel, Anita; Fox, Kimberley; Williams, Charnetta; Stokley, Shannon; Flores, Stephen A.; Barbour, Kamil E.; Harris, La Treace

doi:10.15585/mmwr.mm7020e3

Cited by 196 publications

(196 citation statements)

References 3 publications

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“…Our study found higher vaccination rates associated with increased minority race/ethnicity and population density scores. Our finding of increased rates in areas with higher density aligns with previous evaluations, including a recent report by the CDC that found that higher vaccination in urban relative to rural areas [13] . Of note is that the study identified that populations in rural areas were more likely to travel outside of their county to receive vaccination.…”

Section: Discussionsupporting

confidence: 91%

COVID-19 vaccination rates vary by community vulnerability: A county-level analysis

Brown

Young

Pro

2021

Vaccine

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We used the COVID-19 Community Vulnerability Index and 7 theme scores to assess associations between vulnerability and county-level COVID-19 vaccination (n = 2415 counties) through May 25th, 2021. When comparing vaccination rates among quintiles of CCVI scores, Theme 3 (housing type, transportation, household composition, and disability) was associated with the largest disparity, with the least vulnerable counties (Q1) having 33% higher rates of vaccination among individuals aged 18+ (53.5% vs 40.2%) compared to counties with the highest vulnerability (Q5). Using generalized linear models with binomial distributions and log links, we found that a 10-point increase in the CCVI index, socioeconomic vulnerability, housing type and composition, and epidemiological factors were associated with at least a 1.0 percentage point decline in county-level vaccination. The association between community vulnerability and lower vaccination rates suggests the need for continued efforts for equitable COVID-19 vaccination across marginalized communities.

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Section: Discussionsupporting

confidence: 91%

COVID-19 vaccination rates vary by community vulnerability: A county-level analysis

Brown

Young

Pro

2021

Vaccine

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“…For example, residents of large fringe metropolitan counties might face socioeconomic challenges, including substantial barriers to accessing health care services ( 6 , 7 ). COVID-19 vaccination coverage has been lower in rural than in urban areas, and persons in rural areas are more likely to travel outside their county of residence for vaccination ( 8 ). Efforts to improve vaccination coverage could focus on areas that are more vulnerable with respect to socioeconomics and household composition, while tailoring interventions by urbanicity.…”

Section: Discussionmentioning

confidence: 99%

Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity — United States, December 14, 2020–May 1, 2021

Barry¹,

Dasgupta²,

Weller³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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Disparities in vaccination coverage by social vulnerability, defined as social and structural factors associated with adverse health outcomes, were noted during the first 2.5 months of the U.S. COVID-19 vaccination campaign, which began during mid-December 2020 (1). As vaccine eligibility and availability continue to expand, assuring equitable coverage for disproportionately affected communities remains a priority. CDC examined COVID-19 vaccine administration and 2018 CDC social vulnerability index (SVI) data to ascertain whether inequities in COVID-19 vaccination coverage with respect to county-level SVI have persisted, overall and by urbanicity. Vaccination coverage was defined as the number of persons aged ≥18 years (adults) who had received ≥1 dose of any Food and Drug Administration (FDA)-authorized COVID-19 vaccine divided by the total adult population in a specified SVI category. † SVI was examined overall and by its four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation). Counties were categorized into SVI quartiles, in which quartile 1 (Q1) represented the lowest level of vulnerability and quartile 4 (Q4), the highest. Trends in vaccination coverage were assessed by SVI quartile and urbanicity, which was categorized as large central metropolitan, large fringe metropolitan (areas surrounding large cities, e.g., suburban), medium and small metropolitan, and nonmetropolitan counties. § During December 14, 2020-May 1, 2021, disparities in vaccination coverage by SVI increased, especially in large † Vaccination coverage was calculated by summing the number of vaccinated adults in each SVI category and dividing by the total adult population in the specified SVI category. Population denominators were obtained from the U.S. Census Bureau. § Urbanicity was defined on the basis of the 2013 National Center for Health Statistics urban-rural classification scheme. For this analysis, categories included large central metropolitan counties, large fringe metropolitan counties, medium and small metropolitan counties, and nonmetropolitan counties. Large central metropolitan counties are counties in metropolitan statistical areas (MSAs) with ≥1 million population; large fringe metropolitan counties are counties in MSAs with ≥1 million population that did not qualify as large central metropolitan counties; medium metropolitan counties are counties in MSAs with populations of 250,000-999,999; small metropolitan counties are counties in MSAs with populations <250,000; nonmetropolitan counties are all micropolitan and noncore counties. https://www.cdc.gov/nchs/data_access/urban_rural.htm fringe metropolitan (e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage was lower among adults living in counties with the highest overall SVI; differences were most pronounced in large fringe metropolitan (Q4 coverage = 45.0% versus Q1 coverage = 61.7%) and nonmetropolitan (Q4 = 40.6% versus Q1 = 52.9%) counties. ...

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“…Equitable access to vaccination is critical to improve coverage for persons of all ages who live in communities that are less urban ( 6 ), have higher social vulnerabilities ( 1 , 7 ), and have higher percentages of social determinants of poor health ( 8 ). In a report that pooled findings from two representative surveys of U.S. adults aged 18–39 years, only one half (51.8%) reported that they had been or were planning to be vaccinated, whereas 24.9% reported that they probably or definitely would not be vaccinated, and 23.2% reported that they would probably be vaccinated or were unsure if they would be vaccinated ( 9 ).…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccination Coverage Among Adults — United States, December 14, 2020–May 22, 2021

Diesel¹,

Sterrett²,

Dasgupta³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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152

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Coverage was evaluated by selected community-level characteristics matched to vaccine recipients' county of residence. § § § County-level rankings of social vulnerability from the 2018 CDC Social Vulnerability Index (SVI), which is used to identify community needs during emergencies, were categorized into quartiles based on distribution among all U.S. counties. ¶ ¶ ¶ County-level data on Social Determinants of Health**** obtained from the American Community Survey † † † † were dichotomized based on the median of all U.S. counties. § § § § County-level urbanicity was based on the 2013 National Center for Health Statistics urban-rural classification scheme. ¶ ¶ ¶ ¶ Generalized estimating equation models with binomial regression and an identity link were used to † † † Periods are based on eligibility and other process factors (e.g., phase of vaccine rollout, eligible population, supply, and programs and policy enacted) important in framing the specific needs and constraints at that time. Period 1 represented when most states opened eligibility to health care workers, residents in long-term care facilities, and older adults while there was a highly constrained supply, which overlapped phase 1a, and a portion of phase 1b (https://www.cdc.gov/mmwr/volumes/69/wr/ mm695152e2.htm). Period 2 represented when states were expanding eligibility inconsistently, and supply was becoming more available, which overlapped with phases 1b and 1c. Period 3 represented when all states expanded eligibility to all adults while supply was steady and increased, which overlapped with phases 1c and 2. § § § The following jurisdictions were excluded from all county-level analyses (National Center for Health Statistics urban-rural, SVI, and Social Determinants of Health) due to lack of county-level vaccination data: all counties in Hawaii and eight counties in California for which total population was <20,000. Among all first doses analyzed during December 14, 2020-May 22, 2021, 5.9% were missing county data and were therefore excluded from models. ¶ ¶ ¶ Fifteen elements categorized into four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation) are included in SVI (https:// www.atsdr.cdc.gov/placeandhealth/svi/documentation/pdf/ SVI2018Documentation-H.pdf ). Overall SVI includes all 15 indicators as a composite measure (https://www.atsdr.cdc.gov/placeandhealth/svi/ fact_sheet/fact_sheet.html). One county in New Mexico was excluded because SVI ranking could not be calculated (https://www.atsdr.cdc.gov/ placeandhealth/svi/index.html). **** Measures of Social Determinants of Health from the American Community Survey: percentage of the total population 1) unemployed, 2) uninsured, 3) that earned an income below the federal poverty level, 4) without a computer (e.g., desktop or laptop computer [excludes mobile phones]), 5) with a computer but without Internet access, and 6) identifying as a racial/ethnic group other than non-Hispanic White (https://healt...

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Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–April 10, 2021

Cited by 196 publications

References 3 publications

COVID-19 vaccination rates vary by community vulnerability: A county-level analysis

COVID-19 vaccination rates vary by community vulnerability: A county-level analysis

Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity — United States, December 14, 2020–May 1, 2021

COVID-19 Vaccination Coverage Among Adults — United States, December 14, 2020–May 22, 2021

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