Datta Biplab Kumar, Ghosh Santu, Jaremski Jennifer E, Ansa Benjamin E, Islam K M Monirul, Johnson J Aaron
Author Affiliations: Institute of Public and Preventive Health (Dr Datta, Ms Jaremski, Drs Ansa, Islam, and Johnson), Department of Health Management, Economics and Policy (Drs Datta and Ansa), Department of Biostatistics, Data Science and Epidemiology (Drs Ghosh and Islam), and Department of Community & Behavioral Health Sciences (Dr Johnson), Augusta University, Augusta, Georgia.
J Public Health Manag Pract. 2025;31(5):726-736. doi: 10.1097/PHH.0000000000002151. Epub 2025 Jul 17.
Vaccination coverage against COVID-19 varied across populations. While previous studies primarily documented disparities at a point of time, how uptake rates evolved over time across categories of socioeconomic status (SES) is less visited.
This study utilizing timing (month and year) of the first dose of COVID-19 vaccination, assessed the differences in vaccination progress by different categories of SES across demographic groups in the United States (US).
DESIGN/SETTING/PARTICIPANTS: Using data from the 2022 Behavioral Risk Factor Surveillance System for 135 730 individuals aged 18+ years, living in 29 US states, we estimated Kaplan-Meier failure functions and stratified Cox proportional hazard models for the event of first vaccination.
We assessed how monthly survival probabilities, from December 2020 to December 2022, varied across categories of SES represented by educational attainment and household income in the full sample and in sub-samples of demographic characteristics including age groups, sex, and race and ethnicity.
Estimates of the K-M failure functions suggested a SES gradient of COVID-19 vaccination uptake rates, which were highest among adults with a college degree and income of ≥400% of Federal Poverty Level (FPL), and lowest among adults with educational attainment of less than high school diploma and income of <100% of FPL. Compared to college graduates, adults without a high school diploma were 0.50 (95% confidence interval: 0.48-0.52) times, and compared to adults with income of ≥400% of FPL, adults with income of <100% of FPL were 0.60 times as likely to receive the first dose of vaccination. The hazard ratios of vaccination were 0.61 and 0.70 for adults with high school diploma and some college education, and 0.69 and 0.80 for adults with income of 100% to 199% and 200% to 399% of FPL, respectively. The differences between high and low SES categories were qualitatively similar, though differed by magnitudes across the demographic groups.
Our findings highlight a significant difference in the trends of COVID-19 vaccination uptake between individuals from high and low SES backgrounds and may offer insights for designing policies aimed at equitable vaccination coverage.
针对新冠病毒的疫苗接种覆盖率在不同人群中存在差异。虽然此前的研究主要记录了某一时刻的差异，但社会经济地位（SES）类别之间的接种率随时间如何演变却较少受到关注。
本研究利用首剂新冠疫苗接种的时间（月份和年份），评估了美国不同SES类别在不同人口群体中的疫苗接种进展差异。
设计/背景/参与者：利用2022年行为风险因素监测系统中来自美国29个州的135730名18岁及以上个体的数据，我们估计了首次接种事件的Kaplan-Meier失败函数和分层Cox比例风险模型。
我们评估了从2020年12月到2022年12月，全样本以及按年龄组、性别、种族和民族划分的人口特征子样本中，以教育程度和家庭收入表示的不同SES类别每月生存概率的变化情况。
Kaplan-Meier失败函数估计表明，新冠疫苗接种率存在SES梯度，在拥有大学学位且收入≥联邦贫困线（FPL）400%的成年人中最高，在教育程度低于高中文凭且收入<FPL 100%的成年人中最低。与大学毕业生相比，没有高中文凭的成年人接种首剂疫苗的可能性是其0.50倍（95%置信区间：0.48 - 0.52），与收入≥FPL 400%的成年人相比，收入<FPL 100%的成年人接种首剂疫苗的可能性是其0.60倍。高中文凭和有一些大学教育经历的成年人接种疫苗的风险比分别为0.61和0.70，收入为FPL 100%至199%和200%至399%的成年人接种疫苗的风险比分别为0.69和0.80。高SES类别和低SES类别之间的差异在性质上相似，不过在不同人口群体中的幅度有所不同。
我们的研究结果突出了高SES背景和低SES背景个体在新冠疫苗接种趋势上的显著差异，并可能为设计旨在实现公平疫苗接种覆盖率的政策提供见解。
