Health Care Access and COVID-19 Vaccination in the United States: A Cross-Sectional Analysis.

BACKGROUND

Although federal legislation made COVID-19 vaccines free, inequities in access to medical care may affect vaccine uptake.

OBJECTIVE

To assess whether health care access was associated with uptake and timeliness of COVID-19 vaccination in the United States.

DESIGN

A cross-sectional study.

SETTING

2021 National Health Interview Survey (Q2-Q4).

SUBJECTS

In all, 21,532 adults aged≥18 were included in the study.

MEASURES

Exposures included 4 metrics of health care access: health insurance, having an established place for medical care, having a physician visit within the past year, and medical care affordability. Outcomes included receipt of 1 or more COVID-19 vaccines and receipt of a first vaccine within 6 months of vaccine availability. We examined the association between each health care access metric and outcome using logistic regression, unadjusted and adjusted for demographic, geographic, and socioeconomic covariates.

RESULTS

In unadjusted analyses, each metric of health care access was associated with the uptake of COVID-19 vaccination and (among those vaccinated) early vaccination. In adjusted analyses, having health coverage (adjusted odds ratio [AOR] 1.60; 95% CI: 1.39, 1.84), a usual place of care (AOR 1.58; 95% CI: 1.42, 1.75), and a doctor visit within the past year (AOR 1.45, 95% CI: 1.31, 1.62) remained associated with higher rates of COVID-19 vaccination. Only having a usual place of care was associated with early vaccine uptake in adjusted analyses.

LIMITATIONS

Receipt of COVID-19 vaccination was self-reported.

CONCLUSIONS

Several metrics of health care access are associated with the uptake of COVID-19 vaccines. Policies that achieve universal coverage, and facilitate long-term relationships with trusted providers, may be an important component of pandemic responses.