Health Care Access and COVID-19 Vaccination in the United States: A Cross-Sectional Analysis.

Abstract

Although federal legislation made COVID-19 vaccines free, inequities in access to medical care may affect vaccine uptake. To assess whether health care access was associated with uptake and timeliness of COVID-19 vaccination in the United States. A cross-sectional study. 2021 National Health Interview Survey (Q2-Q4). In all, 21,532 adults aged≥18 were included in the study. Exposures included 4 metrics of health care access: health insurance, having an established place for medical care, having a physician visit within the past year, and medical care affordability. Outcomes included receipt of 1 or more COVID-19 vaccines and receipt of a first vaccine within 6 months of vaccine availability. We examined the association between each health care access metric and outcome using logistic regression, unadjusted and adjusted for demographic, geographic, and socioeconomic covariates. In unadjusted analyses, each metric of health care access was associated with the uptake of COVID-19 vaccination and (among those vaccinated) early vaccination. In adjusted analyses, having health coverage (adjusted odds ratio [AOR] 1.60; 95% CI: 1.39, 1.84), a usual place of care (AOR 1.58; 95% CI: 1.42, 1.75), and a doctor visit within the past year (AOR 1.45, 95% CI: 1.31, 1.62) remained associated with higher rates of COVID-19 vaccination. Only having a usual place of care was associated with early vaccine uptake in adjusted analyses. Receipt of COVID-19 vaccination was self-reported. Several metrics of health care access are associated with the uptake of COVID-19 vaccines. Policies that achieve universal coverage, and facilitate long-term relationships with trusted providers, may be an important component of pandemic responses.