Maryland Transportation Institute (MTI), Department of Civil and Environmental Engineering, University of Maryland, College Park, MD 20742, United States.
Department of Civil and Environmental Engineering, Villanova University, PA 19085, USA.
Vaccine. 2022 Sep 2;40(37):5471-5482. doi: 10.1016/j.vaccine.2022.07.051. Epub 2022 Aug 8.
Vaccine hesitancy has been identified as a major obstacle preventing comprehensive coverage against the COVID-19 pandemic. However, few studies have analyzed the association between ex-ante vaccine hesitancy and ex-post vaccination coverage. This study leveraged one-year county-level data across the contiguous United States to examine whether the prospective vaccine hesitancy eventually translates into differential vaccination rates, and whether vaccine hesitancy can explain socioeconomic, racial, and partisan disparities in vaccine uptake. A set of structural equation modeling was fitted with vaccine hesitancy and vaccination rate as endogenous variables, controlling for various potential confounders. The results demonstrated a significant negative link between vaccine hesitancy and vaccination rate, with the difference between the two continuously widening over time. Counties with higher socioeconomic statuses, more Asian and Hispanic populations, more elderly residents, greater health insurance coverage, and more Democrats presented lower vaccine hesitancy and higher vaccination rates. However, underlying determinants of vaccination coverage and vaccine hesitancy were divergent regarding their different associations with exogenous variables. Mediation analysis further demonstrated that indirect effects from exogenous variables to vaccination coverage via vaccine hesitancy only partially explained corresponding total effects, challenging the popular narrative that portrays vaccine hesitancy as a root cause of disparities in vaccination. Our study highlights the need of well-funded, targeted, and ongoing initiatives to reduce persisting vaccination inequities.
疫苗犹豫已被确定为预防 COVID-19 大流行全面覆盖的主要障碍。然而，很少有研究分析预先存在的疫苗犹豫与事后接种率之间的关系。本研究利用了美国大陆一年的县级数据，检验了前瞻性疫苗犹豫是否最终转化为差异接种率，以及疫苗犹豫是否可以解释疫苗接种率在社会经济、种族和党派方面的差异。使用一组结构方程模型，将疫苗犹豫和接种率作为内生变量进行拟合，同时控制各种潜在的混杂因素。结果表明，疫苗犹豫和接种率之间存在显著的负相关关系，两者之间的差异随着时间的推移不断扩大。社会经济地位较高、亚洲和西班牙裔人口较多、老年居民较多、医疗保险覆盖率较高、民主党人较多的县，疫苗犹豫程度较低，接种率较高。然而，接种率和疫苗犹豫的潜在决定因素在与外生变量的关联方面存在差异。中介分析进一步表明，通过疫苗犹豫从外生变量到接种率的间接效应仅部分解释了相应的总效应，这对将疫苗犹豫视为接种率差异的根本原因的流行观点提出了挑战。我们的研究强调了需要有资金充足、有针对性和持续的举措来减少持续存在的接种不平等现象。
