Associations of race/ethnicity and socioeconomic factors with vaccination among US adults during the COVID-19 pandemic, January to March 2021

Abstract

To date, there has been limited data available to understand the associations between race/ethnicity and socioeconomic and related characteristics with novel coronavirus disease (COVID-19) vaccination in the United States. I leveraged the large, nationally-representative cross-sectional surveys of the U.S. Household Pulse Survey between January and March 2021 with relatively complete race/ethnicity and socioeconomic data to examine national trends in levels of COVID-19 vaccine initiation and intention in adults aged 18–85 years. I further estimated the multivariable associations between race/ethnicity, education, income, and financial hardship with the adjusted prevalence odds ratios of: 1) receipt of ≥1 COVID-19 vaccine dose; and 2) among those unvaccinated, the definite intention to receive a vaccine. I observed persistent disparities in vaccine initiation for non-Hispanic Blacks, Hispanics, and non-Hispanic multiracial/other race persons, and vaccine intention for Blacks and multiracial/other race persons, compared to non-Hispanic Whites and Asians. In late March 2021, the prevalence estimates of Hispanics and Blacks receiving a vaccine were 12-percentage points and 8-percentage points lower than for Whites, respectively. Education and income exhibited dose–response relationships with vaccine initiation (P for trend ≤0.01 and <0.001, respectively). Substantial financial hardship was linked to 35–44% lower adjusted odds of vaccination (P<.001). In this large, nationally-representative study, I found persistent racial/ethnic and socioeconomic disparities in vaccine initiation and intention, more than three months after COVID-19 vaccines first became available. Addressing these persistent racial/ethnic and socioeconomic inequities in vaccination is essential to mitigate the pandemic's higher risks of infection and adverse health outcomes in Hispanic, Black, and socioeconomically-disadvantaged communities.