Socio-economic disparities in exposure to and endorsement of COVID-19 vaccine misinformation and the associations with vaccine hesitancy and vaccination

Abstract

ObjectivesWe examined disparities in vaccine misinformation exposure and endorsement and the associations with vaccine hesitancy and vaccination uptake. Study designPopulation-based survey. MethodsA population-based survey was conducted on 5,002 Hong Kong adults oversampling low socio-economic status (SES, n = 2,200). Information on exposure (13 misinformation statements, total 0–13, median = 2), endorsement (13 statements, score 0–10, high scores indicate higher levels of endorsement, median = 5.75) of misinformation, vaccine hesitancy (14 items, score 1–5), and vaccination (two doses) were collected. Multivariable regression (adjusted β [aβ]) and Poisson regression (adjusted risk ratio [aRR]) adjusting for demographic characteristics were used to examine the associations of exposure to and endorsement of misinformation with vaccine hesitancy and vaccination. ResultsA total of 71.8% of respondents had at least exposure to one vaccine misinformation, and 35.7% had a high level of endorsement (median or above). Respondents with lower SES had a lower exposure (≤2 statements, 57.1% vs 50.1%, P < 0.001) but a higher level of endorsement (36.6% vs 34.9%, P = 0.01) of misinformation. Overall, 72.9% had been vaccinated for two or more doses, with a lower proportion in respondents with lower SES (83.6% vs 61.1%; P < 0.001). Compared with no exposure to misinformation, high levels of exposure and endorsement were associated with vaccine hesitancy (aβ = 0.44, 95% confidence interval 0.40–0.48; aβ = 0.50, 0.47–0.54, respectively) and lower vaccination rates (aRR = 0.98, 0.97–0.99; aRR = 0.92, 0.88–0.96, respectively). Vaccine hesitancy mediated the associations of exposure (fully, 100%) and endorsement (partially, 73%) with vaccination uptake. ConclusionEndorsement of vaccine misinformation in respondents with lower SES was associated with low vaccination uptake.