Abstract
Several studies reported socioeconomic inequalities during the COVID-19 pandemic. We aimed at investigating educational inequalities in COVID-19 vaccination on 22 December 2021. We used the cohort of all residents in the Lazio Region, Central Italy, established at the beginning of the pandemic to investigate the effects of COVID-19. The Lazio Region has 5.5 million residents, mostly distributed in the Metropolitan Area of Rome (4.3 million inhabitants). We selected those aged 35 years or more who were alive and still residents on 22 December 2021. The cohort included data on sociodemographic, health characteristics, COVID-19 vaccination (none, partial, or complete), and SARS-CoV-2 infection. We used adjusted logistic regression models to analyze the association between level of education and no vaccination. We investigated 3,186,728 subjects (54% women). By the end of 2021, 88.1% of the population was fully vaccinated, and 10.3% were not vaccinated. There were strong socioeconomic inequalities in not getting vaccinated: compared with those with a university degree, residents with a high school degree had an odds ratio (OR) of 1.29 (95% confidence interval, CI, 1.27–1.30), and subjects with a junior high or primary school attainment had an OR = 1.41 (95% CI: 1.40–1.43). Since a comprehensive vaccination against COVID-19 could help reduce socioeconomic inequalities raised with the pandemic, further efforts in reaching the low socioeconomic strata of the population are crucial.
Highlights
Media and scientific editorials addressed COVID-19 as a great leveler at the beginning of the pandemic, commentaries and studies on socioeconomic inequalities during the pandemic soon appeared from several countries, raising solid concerns [1,2].Even in high-income countries, compared with the advantaged groups of the population, the disadvantaged have a higher risk of SARS-CoV-2 infection [3], higher hospitalizations for COVID-19 [4], increased admissions to an intensive care unit [3], higher mortality rates [5–7], and lower probability of being tested for SARS-CoV-2 infection [3].Social determinants of health have been deeply investigated in Europe and are present in all countries [8]
We considered gender, age, place of birth (Italy or abroad), number of chronic conditions at the beginning of the pandemic (0, 1, 2, 3, or more), level of education, deprivation index [20], and previous
Compared with subjects included in the study, those excluded for missing information on educational level were younger, more foreigners
Summary
Media and scientific editorials addressed COVID-19 as a great leveler at the beginning of the pandemic, commentaries and studies on socioeconomic inequalities during the pandemic soon appeared from several countries, raising solid concerns [1,2].Even in high-income countries, compared with the advantaged groups of the population, the disadvantaged have a higher risk of SARS-CoV-2 infection [3], higher hospitalizations for COVID-19 [4], increased admissions to an intensive care unit [3], higher mortality rates [5–7], and lower probability of being tested for SARS-CoV-2 infection [3].Social determinants of health have been deeply investigated in Europe and are present in all countries [8]. Media and scientific editorials addressed COVID-19 as a great leveler at the beginning of the pandemic, commentaries and studies on socioeconomic inequalities during the pandemic soon appeared from several countries, raising solid concerns [1,2]. Even in high-income countries, compared with the advantaged groups of the population, the disadvantaged have a higher risk of SARS-CoV-2 infection [3], higher hospitalizations for COVID-19 [4], increased admissions to an intensive care unit [3], higher mortality rates [5–7], and lower probability of being tested for SARS-CoV-2 infection [3]. In the Lazio Region, despite a universal Regional Health Service that aims to provide health care for all, socioeconomic inequalities in health and access to health care have been reported extensively [9–14]. Differences between social positions have been reported in life expectancy [9], in all-cause and cause-specific mortality [10], in the incidence and prognosis of disease [11], in hospitalizations [12], and in adherence to evidence-based drug therapies [13]. In 2020, the vaccines against COVID19 were not available yet, and the vaccination campaign started at the end of December 2020
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