Veterans Affairs Portland Health Care System, Portland, Oregon.
Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland.
JAMA Netw Open. 2023 Feb 1;6(2):e2254387. doi: 10.1001/jamanetworkopen.2022.54387.
COVID-19 vaccination rates remain suboptimal in the US. Identifying factors associated with vaccination can highlight existing gaps and guide targeted interventions to improve vaccination access and uptake.
To describe incidence and patient characteristics associated with primary, first booster, and second booster COVID-19 vaccination in the Veterans Health Administration (VHA).
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study assessed US veterans receiving care in VHA medical centers and outpatient clinics as of December 1, 2020. All VHA enrollees with an inpatient, outpatient, or telehealth encounter in VHA as well as a primary care physician appointment in the preceding 24 months were included.
Demographic characteristics, place of residence, prior SARS-CoV-2 infection, and underlying medical conditions.
Cumulative incidence of primary, first booster, and second booster COVID-19 vaccination through June 2022. Cox proportional hazards regression was used to identify factors independently associated with COVID-19 vaccination.
Among 5 632 413 veterans included in the study, 5 094 392 (90.4%) were male, the median (IQR) age was 66 (51-74) years, 1 032 334 (18.3%) were Black, 448 714 (8.0%) were Hispanic, and 4 202 173 (74.6%) were White. Through June 2022, cumulative incidences were 69.0% for primary vaccination, 42.9% for first booster, and 9.3% for second booster. Cumulative incidence for primary vaccination increased with increasing age, from 46.9% (95% CI, 46.8%-47.0%) among veterans aged 18 to 49 years to 82.9% (95% CI, 82.8%-83.0%) among veterans aged 80 to 84 years. More Black veterans completed primary vaccination (71.7%; 95% CI, 71.6%-71.8%) compared with White veterans (68.9%; 95% CI, 68.9%-69.0%), and more urban-dwelling veterans completed primary vaccination (70.9%; 95% CI, 70.9%-71.0%) compared with highly rural-dwelling veterans (63.8%; 95% CI, 63.4%-64.1%). Factors independently associated with higher likelihood of both primary and booster vaccination included older age, female sex, Asian or Black race, Hispanic ethnicity, urban residence, and lack of prior SARS-CoV-2 infection.
In this cohort study of US veterans, COVID-19 vaccination coverage through June 2022 was suboptimal. Primary vaccination can be improved among younger, rural-dwelling veterans. Greater uptake of booster vaccination among all veterans is needed.
在美国，COVID-19 疫苗接种率仍然不理想。确定与疫苗接种相关的因素可以突出现有的差距，并指导有针对性的干预措施，以改善疫苗接种的可及性和接种率。
描述退伍军人事务部 (VHA) 中初级、首次加强和第二次加强 COVID-19 疫苗接种的发病和患者特征。
设计、地点和参与者：本回顾性队列研究评估了截至 2020 年 12 月 1 日在美国退伍军人事务部医疗中心和门诊接受护理的美国退伍军人。所有在退伍军人事务部有住院、门诊或远程医疗就诊记录，并且在过去 24 个月内有初级保健医生预约的退伍军人事务部参保者均包括在内。
人口统计学特征、居住地、先前的 SARS-CoV-2 感染和潜在的医疗状况。
截至 2022 年 6 月，初级、首次加强和第二次加强 COVID-19 疫苗接种的累积发生率。使用 Cox 比例风险回归来确定与 COVID-19 疫苗接种独立相关的因素。
在这项研究中，共有 5632413 名退伍军人，5094392 名（90.4%）为男性，中位数（IQR）年龄为 66（51-74）岁，1032334 名（18.3%）为黑人，448714 名（8.0%）为西班牙裔，4202173 名（74.6%）为白人。截至 2022 年 6 月，初级疫苗接种的累积发生率为 69.0%，首次加强疫苗接种的累积发生率为 42.9%，第二次加强疫苗接种的累积发生率为 9.3%。随着年龄的增长，初级疫苗接种的累积发生率增加，18 至 49 岁的退伍军人为 46.9%（95%CI，46.8%-47.0%），80 至 84 岁的退伍军人为 82.9%（95%CI，82.8%-83.0%）。与白人退伍军人相比，更多的黑人退伍军人完成了初级疫苗接种（71.7%；95%CI，71.6%-71.8%），与居住在农村地区的退伍军人相比，更多居住在城市的退伍军人完成了初级疫苗接种（70.9%；95%CI，70.9%-71.0%）（63.8%；95%CI，63.4%-64.1%）。与初级和加强疫苗接种更有可能相关的因素包括年龄较大、女性、亚裔或非裔、西班牙裔、城市居住和没有先前的 SARS-CoV-2 感染。
在这项针对美国退伍军人的队列研究中，截至 2022 年 6 月，COVID-19 疫苗接种覆盖率仍然不理想。可以改善较年轻的、居住在农村地区的退伍军人的初级疫苗接种。所有退伍军人都需要增加加强疫苗接种的接种率。
