Marked Inequalities in COVID-19 Vaccination by Racial/Ethnic, Socioeconomic, Geographic, and Health Characteristics, United States, January 6 – February 15, 2021

Abstract

Background: The COVID-19 pandemic has had a substantial adverse impact on the health and wellbeing of populations in the United States (US) and globally. Since the availability of COVID-19 vaccines in December 2020, efforts have been underway to vaccinate priority populations who are at increased risks of COVID-19 infections, morbidity, and mortality, but rigorous and analytical national data on vaccination rates are lacking. Using the latest nationally representative data, we examine disparities in COVID-19 vaccination among US adults aged 18 years and older by a wide range of social determinants. Methods: Using three consecutive rounds of the US Census Bureau’s Household Pulse Survey from January 6 to February 15, 2021 (N=224,458), disparities in vaccination rates by race/ethnicity, socioeconomic status, health insurance, health status, and metropolitan area were modeled by multivariate logistic regression. Results: An estimated 33.6 million or 13.6% of US adults received COVID-19 vaccination. Vaccination rates varied 5-fold across the age range, from a low of 5.8% for adults aged 18-24 to 19.1% for those aged 65-74, and 29.0% for those aged ≥75 years. Males, non-Hispanic Blacks, Hispanics, divorced/separated and single individuals, those with lower education and household income levels, renters, not-employed individuals, the uninsured, and individuals with higher depression levels reported significantly lower rates of vaccination. Controlling for covariates, non-Hispanic Blacks had 11% lower odds and Asians had 50% higher odds of receiving vaccination than non-Hispanic Whites. Adults with less than a high school education had 64% lower adjusted odds of receiving vaccination than those with a Master’s degree. Adults with an annual income of <$25,000 had 33% lower adjusted odds of vaccination than those with a ≥$200,000. Vaccination rates ranged from 10.7% in Riverside-San Bernardino, California to 16.1% in Houston, Texas. Conclusion and Implications for Translation: Ethnic minorities, socioeconomically-disadvantaged individuals, uninsured adults, and those with serious depression reported significantly lower vaccination rates. Equitable vaccination coverage is critical to reducing inequities in COVID-19 health outcomes.