Mohanty Salini, Zurovac Jelena, Barna Michael, Cossrow Nicole, Fiduccia Peter C, Cassell Kelsie, Smith-Howell Esther, McGuinn Valina C, Chatrath Saumya, Shanmugam Priya, Keshaviah Aparna, Poznyak Dmitriy, Evans Alyssa, Feemster Kristen A
Merck & Co., Inc., Rahway, NJ, USA.
Mathematica, Inc., Princeton, NJ, USA.
Vaccine. 2025 Aug 30;62:127452. doi: 10.1016/j.vaccine.2025.127452. Epub 2025 Jul 12.
The COVID-19 pandemic amplified long-standing health disparities in the United States and spurred new research into factors associated with vaccine uptake. While much of the focus has been on COVID-19 vaccines, few studies have examined disparities in pneumococcal vaccination.
Using a retrospective cohort design, we assessed how disparities in county-level pneumococcal vaccination rates by social vulnerability level changed across two periods: before COVID-19 (Medicare: 2016-2019; Medicaid: 2017-2019) and during COVID-19 (2020-2022). Vaccination data were derived from the claims of adult Medicare enrollees (aged ≥65 years) and Medicaid enrollees (aged 19-64), whereas social vulnerability was measured using the Minority Health Social Vulnerability Index. We analyzed changes in vaccine uptake disparities using a difference-in-differences regression model adjusted for demographics and clinical factors.
Both before and during COVID-19, vaccination rates were lower among enrollees residing in high-vulnerability counties. During the pandemic, disparities in pneumococcal vaccination rates decreased among the 37.5 million Medicare enrollees analyzed but increased among the 8.1 million Medicaid enrollees. These patterns remained even after adjusting for enrollee demographic and clinical characteristics.
During COVID-19, Medicare enrollees exhibited reduced disparities in pneumococcal vaccination, possibly due to heightened risk perception, whereas Medicaid enrollees experienced widening gaps, likely driven by socioeconomic barriers. These findings highlight the complex interplay of individual demographic and clinical characteristics, and area-level social vulnerability in shaping vaccine uptake. To improve public health, initiatives should consider these multifaceted factors to effectively address disparities.
2019冠状病毒病（COVID-19）大流行加剧了美国长期存在的健康差异，并促使人们对与疫苗接种相关的因素展开新的研究。虽然大部分关注都集中在COVID-19疫苗上，但很少有研究调查肺炎球菌疫苗接种方面的差异。
我们采用回顾性队列设计，评估了按社会脆弱性水平划分的县级肺炎球菌疫苗接种率差异在两个时期的变化情况：COVID-19之前（医疗保险：2016 - 2019年；医疗补助：2017 - 2019年）和COVID-19期间（2020 - 2022年）。疫苗接种数据来自成年医疗保险参保者（年龄≥65岁）和医疗补助参保者（年龄19 - 64岁）的理赔记录，而社会脆弱性则使用少数族裔健康社会脆弱性指数进行衡量。我们使用针对人口统计学和临床因素进行调整的双重差分回归模型分析了疫苗接种差异的变化。
在COVID-19之前和期间，居住在高脆弱性县的参保者的疫苗接种率均较低。在大流行期间，在分析的3750万医疗保险参保者中，肺炎球菌疫苗接种率的差异有所下降，但在810万医疗补助参保者中却有所增加。即使在对参保者的人口统计学和临床特征进行调整之后，这些模式依然存在。
在COVID-19期间，医疗保险参保者在肺炎球菌疫苗接种方面的差异有所减少，这可能是由于风险认知增强所致，而医疗补助参保者的差距却在扩大，这可能是由社会经济障碍导致的。这些发现凸显了个体人口统计学和临床特征以及地区层面的社会脆弱性在影响疫苗接种方面的复杂相互作用。为改善公共卫生状况，各项举措应考虑这些多方面因素，以有效解决差异问题。
