Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI

Abstract

Despite their disparate rates of infection and mortality, many communities of color report high levels of vaccine hesitancy. This paper describes racial differences in COVID-19 vaccine uptake in Detroit, and assesses, using a mediation model, how individuals’ personal experiences with COVID-19 and trust in authorities mediate racial disparities in vaccination acceptance. The Detroit Metro Area Communities Study (DMACS) is a panel survey of a representative sample of Detroit residents. There were 1012 respondents in the October 2020 wave, of which 856 (83%) were followed up in June 2021. We model the impact of race and ethnicity on vaccination uptake using multivariable logistic regression, and report mediation through direct experiences with COVID as well as trust in government and in healthcare providers. Within Detroit, only 58% of Non-Hispanic (NH) Black residents were vaccinated, compared to 82% of Non-Hispanic white Detroiters, 50% of Hispanic Detroiters, and 52% of other racial/ethnic groups. Trust in healthcare providers and experiences with friends and family dying from COVID-19 varied significantly by race/ethnicity. The mediation analysis reveals that 23% of the differences in vaccine uptake by race could be eliminated if NH Black Detroiters were to have levels of trust in healthcare providers similar to those among NH white Detroiters. Our analyses suggest that efforts to improve relationships among healthcare providers and NH Black communities in Detroit are critical to overcoming local COVID-19 vaccine hesitancy. Increased study of and intervention in these communities is critical to building trust and managing widespread health crises.

Disparities in the offer of COVID-19 vaccination to migrants and non-migrants in Norway: a cross sectional survey study

“…However, differences in receiving an offer cannot fully explain the disparities in vaccination uptake. Unadjusted survey results show lower vaccination rates for migrants as compared to non-migrants among those offered a vaccine (79.9% vs. 91.1%), which is consistent with register data from Norway [9] and research in other countries regarding low vaccination uptake among migrants and ethnic minorities [21]. Nonetheless, our results suggest that issues associated with the necessary precondition of being offered a vaccine also play a role in observed vaccination differences.…”

Demographic Differences in Compliance with COVID-19 Vaccination Timing and Completion Guidelines in the United States

“…Research conducted in Detroit indicated that if NH Black Americans had similar confidence levels in healthcare providers as NH White Americans, 23% of the gap in vaccination uptake could be eliminated. A similar finding was reflected in the level of trust in government between Black and White Detroiters [ 22 ]. Structured racism significantly impacts health education programs that aim to increase patient trust in the medical system.…”

Spillover of Vaccine Hesitancy into Adult COVID-19 and Influenza: The Role of Race, Religion, and Political Affiliation in the United States

“…For instance, Black Americans had a 1.7-times-higher mortality rate, a 2.2-times-higher risk of being hospitalized, and a 1.1-times-higher chance of receiving a COVID-19 diagnosis than NH white Americans as of November 2022 [ 49 ]. This COVID-19 disparity further exacerbated the mistrust and vaccine hesitancy; some researchers found out that, by race/ethnicity, there were substantial differences in healthcare provider trust, and if NH Black Detroiters had levels of healthcare provider confidence comparable to those of NH white Detroiters, 23% of the differences in vaccination uptake by race could be removed [ 50 ].…”