How education and racial segregation intersect in neighborhoods with persistently low COVID-19 vaccination rates in Philadelphia

Abstract

Background COVID-19 infection has disproportionately affected socially disadvantaged neighborhoods. Despite this disproportionate burden of infection, these neighborhoods have also lagged in COVID-19 vaccinations. To date, we have little understanding of the ways that various types of social conditions intersect to explain the complex causes of lower COVID-19 vaccination rates in neighborhoods. Methods We used configurational comparative methods (CCMs) to study COVID-19 vaccination rates in Philadelphia by neighborhood (proxied by zip code tabulation areas). Specifically, we identified neighborhoods where COVID-19 vaccination rates (per 10,000) were persistently low from March 2021 – May 2021. We then assessed how different combinations of social conditions (pathways) uniquely distinguished neighborhoods with persistently low vaccination rates from the other neighborhoods in the city. Social conditions included measures of economic inequities, racial segregation, education, overcrowding, service employment, public transit use, health insurance and limited English proficiency. Results Two factors consistently distinguished neighborhoods with persistently low COVID-19 vaccination rates from the others: college education and concentrated racial privilege. Two factor values together – low college education AND low/medium concentrated racial privilege – identified persistently low COVID-19 vaccination rates in neighborhoods, with high consistency (0.92) and high coverage (0.86). Different values for education and concentrated racial privilege – medium/high college education OR high concentrated racial privilege – were each sufficient by themselves to explain neighborhoods where COVID-19 vaccination rates were not persistently low, likewise with high consistency (0.93) and high coverage (0.97). Conclusions Pairing CCMs with geospatial mapping can help identify complex relationships between social conditions linked to low COVID-19 vaccination rates. Understanding how neighborhood conditions combine to create inequities in communities could inform the design of interventions tailored to address COVID-19 vaccination disparities.

Association Between Racial Segregation and COVID-19 Vaccination Rates

“…In addition, while our analyses showed an overall positive association between higher levels of segregation and higher vaccination rates, we find that much of this association is attenuated after controlling for sociodemographic variables. This is consistent with previous findings that the effect of racial residential segregation on COVID-19 outcomes is exacerbated by both economic and educational factors 12,32. These results emphasize the importance of study design considerations and methodological decisions in analyses when assessing racial equity in COVID-19 vaccinations.…”

“…This is consistent with previous findings that the effect of racial residential segregation on COVID-19 outcomes is exacerbated by both economic and educational factors. 12,32 These results emphasize the importance of study design considerations and methodological decisions in analyses when assessing racial equity in COVID-19 vaccinations. Because of the complex and multifaceted relationships between residential segregation and health outcomes such as vaccination rates, the impact of mediating and moderating factors, interaction effects, and stratified analyses can significantly affect findings.…”

Structural racism and health in the age of COVID‐19: A selective review with policy implications

“…On an individual level, education is associated with adherence to health behaviors that prevent COVID‐19, including social distancing (Zhao et al., 2020), intentions to be vaccinated (Khubchandani et al., 2021; Szilagyi et al., 2021), and rates of death from COVID‐19 (Chen et al., 2022). On a community level, the combination of racial segregation and low levels of education is negatively associated with vaccination rates among community members (Rich et al., 2022).…”

Social Determinants of COVID-19 Vaccination Rates: A Time-Constrained Multiple Mediation Analysis

“…Surprisingly, counties with a higher percentage of residents living in segregated areas (White vs. Non-White but not White vs. African American) had higher vaccination rates (regression coefficient of 0.09). Some studies report that segregated African American communities have lower vaccination rates [30].…”