Heterogeneity in Spatial Inequities in COVID-19 Vaccination Across 16 Large US Cities.

Abstract

Differences in vaccination coverage can perpetuate COVID-19 disparities. We explored the association between neighborhood-level social vulnerability and COVID-19 vaccination coverage in 16 large US cities from the beginning of the vaccination campaign in December 2020 through September 2021. We calculated the proportion of fully vaccinated adults in 866 zip code tabulation areas (ZCTA) of 16 large US cities: Long Beach, Los Angeles, Oakland, San Diego, San Francisco, and San Jose (CA); Chicago (IL); Indianapolis (IN); Minneapolis (MN); New York City (NY); Philadelphia (PA); and Austin, Dallas, Fort Worth, Houston, and San Antonio (TX). We computed absolute and relative total and Social Vulnerability Index(SVI)-related inequities by city. COVID-19 vaccination coverage was 0.75 times (95% CI 0.69-0.81) or 16% (95% CI 12.1-20.2%) percentage points lower in neighborhoods with the highest social vulnerability as compared to those with the lowest. These inequities were heterogeneous, with cities in the West region generally displaying narrower inequities in both the absolute and relative scales. The SVI domains of socioeconomic status and household composition & disability showed the strongest associations with vaccination coverage. Inequities in COVID-19 vaccinations hamper efforts to achieve health equity, as they mirror and could lead to even wider inequities in other COVID-19 outcomes.