MMWR Morb Mortal Wkly Rep. 2023 Jun 30;72(26):728-731. doi: 10.15585/mmwr.mm7226a5.
COVID-19 has disproportionately affected socially vulnerable communities characterized by lower income, lower education attainment, and higher proportions of minority populations, among other factors (1-4). Disparities in COVID-19 incidence and the impact of vaccination on incidence disparities by community income were assessed among 81 communities in Los Angeles, California. Median community vaccination coverage and COVID-19 incidence were calculated across household income strata using a generalized linear mixed effects model with Poisson distribution during three COVID-19 surge periods: two before vaccine availability (July 2020 and January 2021) and the third after vaccines became widely available in April 2021 (September 2021). Adjusted incidence rate ratios (aIRRs) during the peak month of each surge were compared across communities grouped by median household income percentile. The aIRR between communities in the lowest and highest median income deciles was 6.6 (95% CI = 2.8-15.3) in July 2020 and 4.3 (95% CI = 1.8-9.9) in January 2021. However, during the September 2021 surge that occurred after vaccines became widely availabile, model estimates did not identify an incidence disparity between the highest- and lowest-income communities (aIRR = 0.80; 95% CI = 0.35-1.86). During this surge, vaccination coverage was lowest (59.4%) in lowest-income communities and highest (71.5%) in highest-income communities (p<0.001). However, a significant interaction between income and vaccination on COVID-19 incidence (p<0.001) indicated that the largest effect of vaccination on disease incidence occured in the lowest-income communities. A 20% increase in community vaccination was estimated to have resulted in an additional 8.1% reduction in COVID-19 incidence in the lowest-income communities compared with that in the highest-income communities. These findings highlight the importance of improving access to vaccination and reducing vaccine hesitancy in underserved communities in reducing disparities in COVID-19 incidence.
COVID-19 对社会弱势群体的影响不成比例，这些弱势群体的特征是收入较低、教育程度较低、少数族裔比例较高等因素（1-4）。在加利福尼亚州洛杉矶的 81 个社区中，评估了 COVID-19 发病率的差异以及社区收入对疫苗接种发病率差异的影响。在三个 COVID-19 高峰期（疫苗供应前的两个高峰期：2020 年 7 月和 2021 年 1 月，以及 2021 年 4 月疫苗广泛供应后的第三个高峰期），使用具有泊松分布的广义线性混合效应模型，计算了各家庭收入阶层的社区疫苗接种覆盖率和 COVID-19 发病率。在每个高峰期的高峰月份，比较了按家庭收入中位数百分位数分组的社区之间的调整发病率比（aIRR）。在 2020 年 7 月，最低和最高家庭收入十分位数社区之间的 aIRR 为 6.6（95%CI=2.8-15.3），在 2021 年 1 月为 4.3（95%CI=1.8-9.9）。然而，在 2021 年 9 月疫苗广泛供应后发生的 2021 年 9 月高峰期，模型估计没有发现最高和最低收入社区之间的发病率差异（aIRR=0.80；95%CI=0.35-1.86）。在这次高峰期，收入最低的社区（59.4%）和收入最高的社区（71.5%）的疫苗接种率最低（p<0.001）。然而，收入和疫苗接种对 COVID-19 发病率的显著相互作用（p<0.001）表明，疫苗接种对疾病发病率的最大影响发生在收入最低的社区。估计社区疫苗接种率增加 20%，将导致收入最低的社区 COVID-19 发病率比收入最高的社区额外降低 8.1%。这些发现强调了在服务不足的社区增加疫苗接种机会和减少疫苗犹豫的重要性，以减少 COVID-19 发病率的差异。
