Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States.
Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.
Front Public Health. 2023 Oct 12;11:1192748. doi: 10.3389/fpubh.2023.1192748. eCollection 2023.
County-level vaccination barriers (sociodemographic barriers, limited healthcare system resources, healthcare accessibility barriers, irregular healthcare seeking behaviors, history of low vaccination) may partially explain COVID-19 vaccination intentions among U.S. adults. This study examined whether county-level vaccination barriers varied across racial/ethnic groups in the U.S. and were associated with willingness to receive the COVID-19 vaccine. In addition, this study assessed whether these associations differed across racial/ethnic groups.
This study used data from the REACH-US study, a large online survey of U.S. adults ( = 5,475) completed from January 2021-March 2021. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Ordinal logistic regression estimated associations between race/ethnicity and county-level vaccination barriers and between county-level vaccination barriers and willingness to receive the COVID-19 vaccine. Models adjusted for covariates (age, gender, income, education, political ideology, health insurance, high-risk chronic health condition). Multigroup analysis estimated whether associations between barriers and willingness to receive the COVID-19 vaccine differed across racial/ethnic groups.
American Indian/Alaska Native, Black/African American, Hispanic/Latino ELP [English Language Preference (ELP); Spanish Language Preference (SLP)], and Multiracial adults were more likely than White adults to live in counties with higher overall county-level vaccination barriers [Adjusted Odd Ratios (AORs):1.63-3.81]. Higher county-level vaccination barriers were generally associated with less willingness to receive the COVID-19 vaccine, yet associations were attenuated after adjusting for covariates. Trends differed across barriers and racial/ethnic groups. Higher sociodemographic barriers were associated with less willingness to receive the COVID-19 vaccine (AOR:0.78, 95% CI:0.64-0.94), whereas higher irregular care-seeking behavior was associated with greater willingness to receive the vaccine (AOR:1.20, 95% CI:1.04-1.39). Greater history of low vaccination was associated with less willingness to receive the COVID-19 vaccine among Black/African American adults (AOR:0.55, 95% CI:0.37-0.84), but greater willingness to receive the vaccine among American Indian/Alaska Native and Hispanic/Latino ELP adults (AOR:1.90, 95% CI:1.10-3.28; AOR:1.85, 95% CI:1.14-3.01).
Future public health emergency vaccination programs should include planning and coverage efforts that account for structural barriers to preventive healthcare and their intersection with sociodemographic factors. Addressing structural barriers to COVID-19 treatment and preventive services is essential for reducing morbidity and mortality in future infectious disease outbreaks.
县级疫苗接种障碍（社会人口障碍、有限的医疗体系资源、医疗保健可及性障碍、不规则的医疗寻求行为、既往疫苗接种率低）可能部分解释了美国成年人对 COVID-19 疫苗接种的意愿。本研究旨在探讨美国不同种族/族裔群体的县级疫苗接种障碍是否存在差异，并与接种 COVID-19 疫苗的意愿相关。此外，本研究还评估了这些关联在不同种族/族裔群体之间是否存在差异。
本研究使用了来自美国成年人的大型在线调查 REACH-US 研究的数据（n=5475），调查于 2021 年 1 月至 3 月进行。使用 COVID-19 疫苗接种覆盖率指数来衡量县级疫苗接种障碍。使用有序逻辑回归估计种族/族裔与县级疫苗接种障碍之间的关联，以及县级疫苗接种障碍与接种 COVID-19 疫苗的意愿之间的关联。模型调整了协变量（年龄、性别、收入、教育、政治意识形态、医疗保险、高风险慢性健康状况）。多组分析估计了障碍与接种 COVID-19 疫苗的意愿之间的关联在不同种族/族裔群体之间是否存在差异。
与白人成年人相比，美洲印第安人/阿拉斯加原住民、黑人/非裔美国人、西班牙裔/拉丁裔 ELP[英语语言偏好（ELP）；西班牙语语言偏好（SLP）]和多种族成年人更有可能居住在整体县级疫苗接种障碍较高的县（调整后的优势比（AOR）：1.63-3.81）。较高的县级疫苗接种障碍通常与接种 COVID-19 疫苗的意愿较低相关，但在调整了协变量后，这种关联减弱了。趋势因障碍和种族/族裔群体而异。较高的社会人口障碍与接种 COVID-19 疫苗的意愿较低相关（AOR：0.78，95%置信区间：0.64-0.94），而不规则的就医行为与接种疫苗的意愿较强相关（AOR：1.20，95%置信区间：1.04-1.39）。较高的既往低疫苗接种史与黑人/非裔美国人接种 COVID-19 疫苗的意愿较低相关（AOR：0.55，95%置信区间：0.37-0.84），但与美洲印第安人/阿拉斯加原住民和西班牙裔/拉丁裔 ELP 成年人接种疫苗的意愿较强相关（AOR：1.90，95%置信区间：1.10-3.28；AOR：1.85，95%置信区间：1.14-3.01）。
未来的公共卫生应急疫苗接种计划应包括规划和覆盖工作，以应对预防保健方面的结构性障碍及其与社会人口因素的交叉影响。解决 COVID-19 治疗和预防服务方面的结构性障碍对于减少未来传染病爆发的发病率和死亡率至关重要。
