Emerging Socioeconomic Disparities in COVID-19 Vaccine Second-Dose Completion Rates in the United States

Abstract

Although COVID-19 vaccination plans acknowledge a need for equity, disparities in two-dose vaccine initiation have been observed in the United States. We aim to assess if disparity patterns are emerging in COVID-19 vaccination completion. We gathered (n = 843,985) responses between February and November 2021 from a web survey. Individuals self-reported demographics and COVID-19 vaccination status. Dose initiation and completion rates were calculated incorporating survey weights. A multi-variate logistic regression assessed the association between income and completing vaccination, accounting for other demographics. Overall, 57.4% initiated COVID-19 vaccination, with 84.5% completing vaccination. Initiation varied by income, and we observed disparities in completion by occupation, race, age, and insurance. Accounting for demographics, higher incomes are more likely to complete vaccination than lower incomes. We observe disparities in completion across annual income. Differences in COVID-19 vaccination completion may lead to two tiers of protection in the population, with certain sub-groups being better protected from future infection.

COVID-19 Vaccine Hesitancy: The Role of Socioeconomic Factors and Spatial Effects

“…In addition to transportation barriers, particularly for residents living in rural communities, our regression results confirm the role of socioeconomic factors that reflect economic insecurity, particularly educational attainment, that also affects income earnings. These findings complement the existing literature that focuses on social inequity in COVID-19 vaccinations [ 6 , 7 , 8 , 9 , 11 ]. On the other hand, our empirical results contradict earlier studies that reported challenges facing racial/ethnic minorities in the U.S. [ 19 , 20 ].…”

“…The objective of our empirical work is to evaluate the sources of under-vaccination during the COVID-19 pandemic. In light of the existing literature that emphasizes the role of socioeconomic and demographic factors [ 6 , 7 , 8 , 10 , 11 , 12 , 13 ], we consider the various components that make up the U.S. Centers for Disease Control and Prevention’s [ 26 ] Social Vulnerability Index (SVI). The SVI is aimed at helping public health officials and policymakers better prepare for disease outbreaks and other disasters.…”

“…Most studies on the sources of unwillingness to vaccinate draw inferences from cross-sectional survey data. The consensus points to a higher hesitancy among the less-educated, females, racial/ethnic minorities, people living in rural areas, and those with lower income or economic security [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. In the United States, the economically disadvantaged population is predominantly Hispanic or Black.…”

When mistrust in the government and scientists reinforce social inequalities in vaccination against Covid-19

“…The exclusion of the poorest part of the population from the social contract could lead to a diminished sensitivity towards the national solidarity dimension of vaccination, strongly emphasised in the public discourse on prevention in France. The low rates of vaccination among the most deprived, also found in a US survey [9], probably also relates to the fact that they generally have poor access to healthcare than others for given needs. [12] Our results underline the need to develop outreach strategies targeting the poorest, the least educated people, and the racialised minorities, as recommended by Hanif back in 2020.…”

“…[1][2][3] Making Covid-19 vaccines available does not necessarily lead to a very large population vaccine coverage, as shown by the percentages of people who are still not vaccinated in Western countries [4], even when these vaccines are free. Recent studies in the UK, in the US and in Norway [5][6][7][8][9][10] have shown that the most socially disadvantaged and racialised social groups are the least vaccinated. In light of their high risk of infection and mortality from Covid-19 [1], it appears all the more important to understand why they are less likely to be reached by Covid-19 vaccine programmes.…”