Geographic Heterogeneity in Behavioral and Social Drivers of COVID-19 Vaccination

Abstract

IntroductionLittle is known about how drivers of COVID-19 vaccination vary across the U.S. To inform vaccination outreach efforts, this study explores geographic variation in correlates of COVID-19 non-vaccination among adults.MethodsParticipants were a nationally representative sample of U.S. adults identified through random-digit-dialing for the National Immunization Survey-Adult COVID Module. Analyses examined the geographic and temporal landscape of constructs in the Behavioral and Social Drivers of vaccination (BeSD) Framework among unvaccinated respondents from May to December 2021 (n=531,798) and sociodemographic and geographic disparities and BeSD predictors of COVID-19 non-vaccination from October to December 2021 (n=187,756).ResultsNational coverage with at least 1 dose of COVID-19 vaccine was 79.3% by December 2021, with substantial geographic heterogeneity. Regions with the largest proportion of unvaccinated persons who would probably get a COVID-19 vaccine or were unsure resided in the Southeast and Midwest (Health and Human Services Regions 4 and 5). Both regions had similar temporal trends regarding concerns about COVID-19 and confidence in vaccine importance, though Region 4 had especially low confidence in vaccine safety in December 2021, lowest in Florida (5.5%) and highest in North Carolina (18.0%). The strongest BeSD correlate of not receiving a COVID-19 vaccination was lower confidence in COVID-19 vaccine importance (aPR=5.19, 95% CI=4.93, 5.47; strongest in the Northeast, Southwest, and Mountain West, and weakest in the Southeast and Midwest). Other BeSD correlates also varied by region.ConclusionsContributors to non-vaccination showed substantial geographic heterogeneity. Strategies to improve COVID-19 vaccination uptake may need to be tailored regionally.