Division of Infectious Diseases, Department of Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2021 Aug 2;4(8):e2121931. doi: 10.1001/jamanetworkopen.2021.21931.
Significant differences in hesitancy to receive COVID-19 vaccination by race/ethnicity have been observed in several settings. Racial/ethnic differences in COVID-19 vaccine hesitancy among health care workers (HCWs), who face occupational and community exposure to COVID-19, have not been well described.
To assess hesitancy to COVID-19 vaccination among HCWs across different racial/ethnic groups and assess factors associated with vaccine hesitancy.
DESIGN, SETTING, AND PARTICIPANTS: This survey study was conducted among HCWs from 2 large academic hospitals (ie, a children's hospital and an adult hospital) over a 3-week period in November and December 2020. Eligible participants were HCWs with and without direct patient contact. A 3-step hierarchical multivariable logistic regression was used to evaluate associations between race/ethnicity and vaccine hesitancy controlling for demographic characteristics, employment characteristics, COVID-19 exposure risk, and being up to date with routine vaccinations. Data were analyzed from February through March 2021.
Vaccine hesitancy, defined as not planning on, being unsure about, or planning to delay vaccination, served as the outcome.
Among 34 865 HCWs eligible for this study, 12 034 individuals (34.5%) completed the survey and 10 871 individuals (32.2%) completed the survey and reported their race/ethnicity. Among 10 866 of these HCWs with data on sex, 8362 individuals (76.9%) were women, and among 10 833 HCWs with age data, 5923 individuals (54.5%) were younger than age 40 years. (Percentages for demographic and clinical characteristics are among the number of respondents for each type of question.) There were 8388 White individuals (77.2%), 882 Black individuals (8.1%), 845 Asian individuals (7.8%), and 449 individuals with other or mixed race/ethnicity (4.1%), and there were 307 Hispanic or Latino individuals (2.8%). Vaccine hesitancy was highest among Black HCWs (732 individuals [83.0%]) and Hispanic or Latino HCWs (195 individuals [63.5%]) (P < .001). Among 5440 HCWs with vaccine hesitancy, reasons given for hesitancy included concerns about side effects (4737 individuals [87.1%]), newness of the vaccine (4306 individuals [79.2%]), and lack of vaccine knowledge (4091 individuals [75.2%]). The adjusted odds ratio (aOR) for vaccine hesitancy was 4.98 (95% CI, 4.11-6.03) among Black HCWs, 2.10 (95% CI, 1.63-2.70) among Hispanic or Latino HCWs, 1.48 (95% CI, 1.21-1.82) among HCWs with other or mixed race/ethnicity, and 1.47 (95% CI, 1.26-1.71) among Asian HCWs compared with White HCWs (P < .001). The aOR was decreased among Black HCWs when adjusting for employment characteristics and COVID-19 exposure risk (aOR, 4.87; 95% CI, 3.96-6.00; P < .001) and being up to date with prior vaccines (aOR, 4.48; 95% CI, 3.62-5.53; P < .001) but not among HCWs with other racial/ethnic backgrounds.
This study found that vaccine hesitancy before the authorization of the COVID-19 vaccine was increased among Black, Hispanic or Latino, and Asian HCWs compared with White HCWs. These findings suggest that interventions focused on addressing vaccine hesitancy among HCWs are needed.
在多个环境中观察到了不同种族/民族对 COVID-19 疫苗接种的犹豫程度存在显著差异。在面临职业和社区 COVID-19 暴露风险的医护人员（HCWs）中，COVID-19 疫苗犹豫的种族/民族差异尚未得到很好的描述。
评估不同种族/民族的 HCWs 对 COVID-19 疫苗接种的犹豫程度，并评估与疫苗犹豫相关的因素。
设计、地点和参与者：这项调查研究是在 2020 年 11 月和 12 月的 3 周期间，在 2 家大型学术医院（即儿童医院和成人医院）的 HCWs 中进行的。符合条件的参与者包括有和没有直接病人接触的 HCWs。使用 3 步分层多变量逻辑回归来评估种族/民族与疫苗犹豫之间的关联，控制人口统计学特征、就业特征、COVID-19 暴露风险以及常规疫苗接种的及时性。数据于 2021 年 2 月至 3 月进行分析。
疫苗犹豫，定义为不打算、不确定或计划延迟接种，作为结果。
在符合这项研究条件的 34865 名 HCWs 中，有 12034 人（34.5%）完成了调查，有 10871 人（32.2%）完成了调查并报告了他们的种族/民族。在 10866 名有性别数据的 HCWs 中，有 8362 人（76.9%）是女性，在 10833 名有年龄数据的 HCWs 中，有 5923 人（54.5%）年龄小于 40 岁。（人口统计学和临床特征的百分比是每种类型问题的受访者数量。）有 8388 名白人（77.2%）、882 名黑人（8.1%）、845 名亚洲人（7.8%）和 449 名其他或混合种族/民族的人（4.1%），还有 307 名西班牙裔或拉丁裔（2.8%）。黑人和西班牙裔或拉丁裔 HCWs 的疫苗犹豫率最高（分别为 830 人[83.0%]和 195 人[63.5%]）（P<0.001）。在 5440 名有疫苗犹豫的 HCWs 中，犹豫的原因包括对副作用的担忧（4737 人[87.1%]）、疫苗的新颖性（4306 人[79.2%]）和缺乏疫苗知识（4091 人[75.2%]）。黑人和西班牙裔或拉丁裔 HCWs 的疫苗犹豫的调整后优势比（aOR）分别为 4.98（95%CI，4.11-6.03）、2.10（95%CI，1.63-2.70）、1.48（95%CI，1.21-1.82）和 1.47（95%CI，1.26-1.71），与白人 HCWs 相比（P<0.001）。当调整就业特征和 COVID-19 暴露风险（aOR，4.87；95%CI，3.96-6.00；P<0.001）以及及时接种先前疫苗（aOR，4.48；95%CI，3.62-5.53；P<0.001）时，黑人和西班牙裔或拉丁裔 HCWs 的 aOR 降低，但其他种族/民族背景的 HCWs 的 aOR 则没有降低。
这项研究发现，在 COVID-19 疫苗获得授权之前，与白人 HCWs 相比，黑人和西班牙裔或拉丁裔以及亚裔 HCWs 的疫苗犹豫程度更高。这些发现表明，需要针对 HCWs 开展疫苗犹豫干预措施。
