Geographic Disparities Research Articles

Global burden and future trends in psoriasis epidemiology: insights from the global burden of disease study 2019 and predictions to 2030.

Millions of people worldwide are affected by psoriasis, one of the most prevalent skin conditions. Currently, there is a lack of high-quality epidemiological reports on psoriasis. This study aimed to reveal trends in psoriasis epidemiology in 1990-2019. Using data from the GBD study 2019, we examined psoriasis epidemiology globally and across regions defined by the social-demographic index (SDI). Trends in incidence, prevalence, and disability-adjusted life year (DALY) rates were assessed using estimated annual percentage changes (EAPC)s. Age-period-cohort analysis examined risk variations, and decomposition analysis identified factors impacting the psoriasis burden. A Bayesian Age-Period-Cohort model predicted future incidence. Frontier analysis associated psoriasis outcomes with socio-demographic development. In 2019, the global psoriasis burden included 4,622,594 incidence, 40,805,386 prevalence, and 3,505,736 DALY cases. Despite variations in SDI regions, the overall trend showed a decline in psoriasis rates from 1990 to 2019 (EAPC = - 0.76). The age-specific analysis indicated that the highest incidence of psoriasis was observed among individuals aged 40-64years (global, 1,606,429). Epidemiological shifts contributed negatively to global incidence and DALYs by - 80.52% and - 103.06%, respectively. Countries like San Marino and Spain displayed the highest effective differences in the decomposition analysis. By 2030, while incidence cases per 10,000 might rise (487.36, 423.62 to 551.10), age-standardized incidence rates per 100,000 were predicted to decline (53.67, 0.00 to 259.99). This research revealed a global decline in psoriasis incidence rate from 1990 to 2019, with predictions suggesting this trend continues through 2030. Geographic disparities underscore the importance of tailored healthcare policies.

Restricted spatial models for the analysis of geographic and racial disparities in the incidence of low birthweight in Pennsylvania

The incidence of low birthweight is a common measure of public health due to the increased risk of complications associated with infants having low and very low birthweights. Moreover, many factors that increase the risk of an infant having a low birthweight can be linked to the mother’s socioeconomic status, leading to large racial/ethnic disparities in its incidence. Our objective is thus to analyze the incidence of low and very low birthweight in Pennsylvania counties by race/ethnicity. Due to the small number of births in many Pennsylvania counties when stratified by race/ethnicity, our methods must walk a fine line: While we wish to leverage spatial structure to improve the precision of our estimates, we also wish to avoid oversmoothing the data, which can yield spurious conclusions. As such, we develop a framework by which we can measure (and control) the informativeness of our spatial model. To analyze the data, we first model the Pennsylvania birth data using the conditional autoregressive model to demonstrate the extent to which it can lead to oversmoothing. We then reanalyze the data using our proposed framework and highlight its ability to detect (or not detect) evidence of racial/ethnic disparities in the incidence of low birthweight.

Discrepancies in Mass Shootings and Access to Trauma Care Across the United States, 2014-2018.

The United States has one of the highest rates of gun violence and mass shootings. Timely medical attention in such events is critical. The objective of this study was to assess geographic disparities in mass shootings and access to trauma centers. Data for all Level I and II trauma centers were extracted from the American College of Surgeons and the Trauma Center Association of America registries. Mass shooting event data (4+ individuals shot at a single event) were taken from the Gun Violence Archive between 2014 and 2018. A total of 564 trauma centers and 1672 mass shootings were included. Ratios of the number of mass shootings vs trauma centers per state ranged from 0 to 11.0 mass shootings per trauma center. States with the greatest disparity (highest ratio) included Louisiana and New Mexico. States in the southern regions of the US experience the greatest disparity due to a high burden of mass shootings with less access to trauma centers. Interventions are needed to increase access to trauma care and reduce mass shootings in these medically underserved areas.

Rural reinvestment: A path forward to addressing geographic health inequities.

The Centers for Disease Control and Prevention (CDC) produced two reports, in 2017 and 2021, highlighting rural inequities across the five leading causes of death. These reports were pivotal in bringing attention to geographic disparities in preventable deaths. The 2024 update provides similar focus and attention and shows concerning trends over time, given that inequities have increased significantly across four of the five leading causes of death. The purpose of this commentary is to highlight these ongoing health inequities and create dialogue among public health professionals as to how we regain trust and work collaboratively with rural communities to address these ongoing and growing challenges.

Sensing the pulse of the pandemic: unveiling the geographical and demographic disparities of public sentiment toward COVID-19 through social media

ABSTRACT Social media offers a unique lens to observe large-scale, spatial-temporal patterns of users’ reactions toward critical events. However, social media use varies across demographics, with younger users being more prevalent compared to older populations. This difference introduces biases in data representativeness, and analysis based on social media without proper adjustment will lead to overlooking the voices of digitally marginalized communities and inaccurate estimations. This study explores solutions to pinpoint and alleviate the demographic biases in social media analysis through a case study estimating the public sentiment about COVID-19 using Twitter data. We analyzed the pandemic-related Twitter data in the U.S. during 2020–2021 to (1) elucidate the uneven social media usage among demographic groups and the disparities of their sentiments toward COVID-19, (2) construct an adjusted public sentiment measurement based on social media, the Sentiment Adjusted by Demographics (SAD) index, to evaluate the spatiotemporal varying public sentiment toward COVID-19. The results show higher proportions of female and adolescent Twitter users expressing negative emotions to COVID-19. The SAD index unveils that the public sentiment toward COVID-19 was most negative in January and February 2020 and most positive in April 2020. Vermont and Wyoming were the most positive and negative states toward COVID-19.

Abstract 1481: Disparity landscapes of HBV integration in hepatocellular carcinoma: Mechanistic characterization and functional implications

Abstract Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and is a common malignancy worldwide. About half of all new liver cancers worldwide each year occur in China due to a high prevalence of hepatitis B virus (HBV) infection. HBV DNA integrates into the human genome, disrupting the endogenous tumor suppressors/regulatory genes or enhancing the activity of proto-oncogenes. It would be useful to examine the different NGS-based databases to provide a more unbiased and comprehensive survey of HBV integration. We aimed to take advantage of publicly available datasets of different regional cohorts to determine the disparity landscapes of integration events among sample cohorts, tissue types, chromosomal positions, individual host and viral genes, and genic locations. By comparing HCC tumor with non-tumorous liver, landscape of HBV integration was delineated at gene-independent and gene-dependent manners. Moreover, we performed mechanistic investigations on how HBV-TERT integration led to TERT activation and derived a score to predict patients’ prognostication according to their clonal disparity landscape of HBV integration. We revealed a global geographical disparity of HBV integration that the landscape of HBV integration between HCC and non-tumorous liver varied in regional cohorts, suggesting the different degrees of clonal enrichment. In the Mainland China, Hong Kong and Mongolia cohorts, HCC tumors had higher numbers of events than the non-tumorous livers, whereas in the French and US cohorts, the reverse was true. Moreover, most HBV integrations were positionally enriched at the telomeres and centromeres, and this highlighted the novel co-involvement of HBV integration at these regions, which likely introduces greater genomic instability. Furthermore, we constructed a large meta-cohort of multiple ethnicities to refine the landscape of HBV integration. This enabled the identification of events at key HCC-related genes (e.g., TERT, KMT2B, and CCNA2) and gene families (e.g., cyclin, cadherin, and contactin). As TERT is the most frequently integrated gene by HBV, we further investigated the mechanistic modulation of TERT transcription activation by combining and analyzing our in-house sample cohort with a previous report and luciferase reporter assays. This revealed the positive concurrent influence by both the orientation and relative distance of HBV integration (closer to transcription start site) from the TERT gene. Additionally, we observed clonal disparity of HBV integration among patients and the higher level of the clonal disparity score correlated with poor prognostication of HCC patients. Our study uncovered the different levels of clonal enrichment of HBV integration and identified mechanistic insights and prognostic biomarker. This strengthens our understanding of HBV-associated hepatocarcinogenesis. Citation Format: Xueying Lyu, Karen Man-Fong Sze, Joyce Man-Fong Lee, Abdullah Husain, Irene Oi-Lin Ng, Daniel Wai-Hung Ho. Disparity landscapes of HBV integration in hepatocellular carcinoma: Mechanistic characterization and functional implications [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1481.

HOUSE PRICE VOLATILITY IN CHINA: A PERVASIVE PATTERN WITH GEOGRAPHIC DISPARITY

The booming real estate sector has been regarded as the “gray rhino” risk emerging in China over the past decade. Yet, the house price volatility per se has not been thoroughly examined. Filling the gap in the literature, this paper explores the house price volatility and its determinants for 70 large and medium-sized cities in China, using an extensive monthly data set from 2005 to 2019. We find evidence of significant geographical disparities in both the GARCH effects and the best-fitted volatility specification. Significant GARCH effects are found in 57 cities, among which 40% of cities show a persistent volatility pattern. We also find that both the house price volatility pattern and the associated volatility value are affected significantly by education and healthcare amenities.

Availability and utilization of endoscopic retrograde cholangiopancreatography at children's hospitals.

No study has explored whether availability of endoscopic retrograde cholangiopancreatography (ERCP) is adequate and equitable across US children's hospitals. We hypothesized that ERCP availability and utilization differs by geography and patient factors. Healthcare encounter data from 2009 to 2019 on children with pancreatic and biliary diseases from the Pediatric Health Information System were analyzed. ERCP availability was defined as treatment at a hospital that performed pediatric ERCP during the year of service. From 2009 to 2019, 37,946 children (88,420 encounters) had a potential pancreatic or biliary indication for ERCP; 7066 ERCPs were performed. The commonest pancreatic diagnoses leading to ERCP were chronic (47.2%) and acute pancreatitis (43.2%); biliary diagnoses were calculus (68.3%) and obstruction (14.8%). No ERCP was available for 25.0% of pancreatic encounters and 8.1% of biliary encounters. In multivariable analysis, children with public insurance, rural residence, or of Black race were less likely to have pancreatic ERCP availability; those with rural residence or Asian race were less likely to have biliary ERCP availability. Black children or those with public insurance were less likely to undergo pancreatic ERCP where available. Among encounters for calculus or obstruction, those of Black race or admitted to hospitals in the West were less likely to undergo ERCP when available. One-in-four children with pancreatic disorders and one-in-12 with biliary disorders may have limited access to ERCP. We identified racial and geographic disparities in availability and utilization of ERCP. Further studies are needed to understand these differences to ensure equitable care.

A web tool for exploring the usage of medicines in hospitals in England.

Datasets on the amounts of different medicines used over time and location are a valuable resource, with the power to reveal insights into healthcare trends, cost efficiencies, and geographic disparities. In England, primary care prescription data has been openly accessible for analysis for some time through a web tool, providing significant benefits. Since 2020, the National Health Service in England has also released data on secondary care medicine usage, processed from stock control databases, which provides detailed information on medicine usage within hospitals. This is an important dataset, but until now has been available only in a raw form that requires considerable technical skills to be used for even the analysis of basic trends. I have built a web application that enables anyone to easily analyse trends in this data, which is available at hospitalmedicines.genomium.org.

Abstract P195: Metabolites Mediate the Association of the MIND Diet With Hypertension and Chronic Kidney Disease

The Mediterranean-DASH diet intervention for neurodegenerative delay (MIND), is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. The Mediterranean and DASH diets are associated with decreased risk of cardiometabolic disease; however, less is known regarding the association of the MIND diet with cardiometabolic disease. The objectives of this analysis were (1) to determine if the MIND diet is associated with prevalent hypertension and chronic kidney disease (CKD) and (2) to identify metabolites associated with the MIND diet and if these metabolites mediate the association of the MIND diet with hypertension and CKD. In the REasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort, we examined the association of the MIND diet with prevalent hypertension and CKD. Fully adjusted models included age, sex, race, calories, alcohol, smoking, education, exercise, income, region, BMI, lipidemia, history of coronary artery disease, and diabetes. In the REGARDS stroke case-cohort sub-study, 357 metabolites were measured in baseline plasma. Weighted linear regression models were used to test the association between MIND diet score and metabolites adjusting for age, sex, race, calories, alcohol, and smoking. Weighted logistic regression models were used to test the association between MIND-metabolites and hypertension and CKD adjusting for age, race, sex, BMI, alcohol, and smoking. Mediation analysis was conducted to examine metabolites mediating the association between MIND diet and hypertension and CKD. Sensitivity analyses were conducted in the cohort random controls. A higher MIND diet score was associated with lower odds of hypertension (odds ratio [OR] 0.97, 95% CI 0.96-0.99; p=0.01) and CKD (OR 0.88, 95% CI 0.86-0.91; p<0.0001). Fifty-one metabolites were associated with the MIND diet (MIND-metabolites). Three MIND-metabolites were associated with greater odds of hypertension; however, these associations were attenuated in the fully adjusted models. Twelve MIND-metabolites were associated with greater odds of CKD. Mediation analyses indicated dimethylguanidino valeric acid (DMGV), guanosine, and C7 carnitine to mediate the association between MIND diet and hypertension. DMGV, guanosine, gluconic acid, S-Adenosyl-L-homocysteine, C7 carnitine, and 5 triacylglycerols mediated the association between MIND diet and CKD. Higher adherence to the MIND diet is associated with a lower likelihood of hypertension and CKD. MIND diet-related metabolites were found to be associated with hypertension and CKD and may provide insight to metabolic pathways linking diet and disease.

Disability-adjusted life years from bone and joint infections associated with antimicrobial resistance: an insight from the 2019 Global Burden of Disease Study.

Bone and joint infections, complicated by the burgeoning challenge of antimicrobial resistance (AMR), pose significant public health threats by amplifying the disease burden globally. We leveraged results from the 2019 Global Burden of Disease Study (GBD) to explore the impact of AMR attributed to bone and joint infections in terms of disability-adjusted life years (DALYs), elucidating the contemporary status and temporal trends. Utilizing GBD 2019 data, we summarized the burden of bone and joint infections attributed to AMR across 195 countries and territories in the 30 years from 1990 to 2019. We review the epidemiology of AMR in terms of age-standardized rates, the estimated DALYs, comprising years of life lost (YLLs) and years lived with disability (YLDs), as well as associations between DALYs and socio-demographic indices. The GBD revealed that DALYs attributed to bone and joint infections associated with AMR have risen discernibly between 1990 and 2019 globally. Significant geographical disparities and a positive correlation with socio-demographic indicators were observed. Staphylococcus aureus infections, Group A Streptococcus, Group B Streptococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter-related bone and joint infections were associated with the highest DALYs because of a high proportion of antimicrobial resistance. Countries with limited access to healthcare, suboptimal sanitary conditions, and inconsistent antibiotic stewardship were markedly impacted. The GBD underscores the escalating burden of bone and joint infections exacerbated by AMR, necessitating urgent, multi-faceted interventions. Strategies to mitigate the progression and impact of AMR should emphasize prudent antimicrobial usage and robust infection prevention and control measures, coupled with advancements in diagnostic and therapeutic modalities.

Determinants of global cardiac implantable electrical device remote monitoring utilization – Results from an international survey

Despite near-global availability of remote monitoring (RM) in patients with cardiac implantable electronic devices (CIED), there is a high geographical variability in the uptake and use of RM. The underlying reasons for this geographic disparity remain largely unknown. To study the determinants of worldwide RM utilization and identify locoregional barriers of RM uptake. An international survey was administered to all CIED clinic personnel using the Heart Rhythm Society global network collecting demographic information, as well as information on the use of RM, the organization of the CIED clinic, and details on local reimbursement and clinic funding. The most complete response from each center was included in the current analysis. Stepwise forward multivariate linear regression was performed to identify determinants of the percentage of patients with a CIED on RM. A total of 302 responses from 47 different countries were included, 61.3% by physicians and 62.3% from hospital-based CIED clinics. The median percentage of CIED patients on RM was 80% (interquartile range, 40-90). Predictors of RM use were gross national income per capita (0.76% per US$1000, 95% CI 0.72-1.00, P < .001), office-based clinics (7.48%, 95% CI 1.53-13.44, P=.014), and presence of clinic funding (per-patient payment model 7.90% [95% CI 0.63-15.17, P = .033); global budget 3.56% (95% CI -6.14 to 13.25, P = .471]). The high variability in RM utilization can partly be explained by economic and structural barriers that may warrant specific efforts by all stakeholders to increase RM utilization.

Sociodemographic Disparity of Asthma Calls in Wichita, Oklahoma City, and Tulsa

Asthma is a chronic respiratory disease that effects millions of people worldwide and disproportionately effect different sociodemographic groups, leading to injustices. These disproportionate effects are well documented in large cities. This study documents the distribution of asthma calls across different sociodemographic groups in the smaller cities of Wichita, Kansas, Tulsa, Oklahoma, and Oklahoma City, Oklahoma. Utilizing data from the 2010 United States Census and emergency medical service data, this study reveals that asthma calls are more prevalent in areas with higher concentrations of minority and low-income populations. This study underscores the significance of geographic and socioeconomic disparities in asthma occurrences and the need for targeted public health interventions to address these challenges.

Traditional medicinal plants used for rheumatoid arthritis and immune system disorders treatment in the Casablanca-Settat region, Morocco: An ethnopharmacological study

Rheumatoid arthritis, classified as an immune system disorder, stands as a prevalent condition that presents considerable challenges to healthcare systems worldwide. This study was delving into the realm of traditional medicine to explore the use of medicinal plants for the treatment of rheumatoid arthritis and immune system disorders in the Casablanca-Settat region of Morocco. With a focus on ethnopharmacological insights, a comprehensive survey was conducted involving 372 participants, including herbalists and patients, to document the local knowledge and practices associated with these conditions. The findings revealed a noteworthy reliance on traditional medicinal knowledge, with a prominent role played by females across different age groups. A diverse spectrum of 88 plant species hailing from 45 distinct families was identified, where in the Myrtaceae, Oleaceae, and Zingibneraceae families garnered prominence as the most endorsed choices. Noteworthy among these, Zingiber officinale and Curcuma longa emerged as highly favored species, boasting robust anti-inflammatory and immunomodulatory attributes. The study also offers insight regarding preferences concerning administration methods, highlighting the salience of oral consumption and infusion as the predominant modes of preparation. Nevertheless, the observed variability in dosage utilization underscores the traditional therapeutic paradigmsintricacies. Geographic disparities were discernible as well, with certain species displaying a region-specific usage pattern, further enriching the understanding of local herbal practices. Moreover, the study identified endemic species such as Olea europaea, Teucrium polium, Argania spinosa, and Withania adpressa contributing to the safeguarding of the region's indigenous botanical heritage. In conclusion, this study contributes to a deeper understanding of the traditional management of RA and immune system disorders in the Casablanca-Settat region. The documented plant species, practices, and preferences offer valuable insights into potential sources of anti-inflammatory and immunomodulatory agents.

Mapping the Landscape: Simulation Centers in Portugal.

Simulation-based training has emerged as a vital component of healthcare education. This study aims to characterize Portuguese simulation centers concerning their geographic distribution and key features, providing stakeholders with valuable insights to inform strategic decisions. A cross-sectional survey-based study was conducted over two years (2021-2023) to investigate the geographical dispersion and characteristics of simulation centers in Portugal. Descriptive statistics and thematic analysis were used to analyze data. Twenty-three Portuguese simulation centers were included. Major urban areas and coastal regions bring together 20 simulation centers (86.96%). A large percentage (71.93%) of centers were affiliated with academic institutions, while five centers (21.74%) were clinically affiliated. Emergency care, Anesthesiology and Intensive Medicine, Pediatrics, andGynecology and Obstetrics were identified as the national key areas of intervention. Significant geographical disparity raises concerns about unequal access to professional training opportunities using simulation. Centers should be encouraged to incorporate developing technologies and innovative pedagogical methodologies and to expand their training repertoire into relatively uncharted territories. Several issues have been identified within the national simulation network. Stakeholders and policymakers should prioritize equitable access, bolster the prevalence of clinical affiliated centers, foster innovation, and facilitate strategic coordination.

Applications of Learning Analytics in Latin America

Learning analytics (LA) is a key research domain within educational technology. This field harnesses data analysis, unlocking tangible advantages for educators and learners. Despite extensive research, geographical disparities in adoption remain, with certain regions still in developing stages. Within this scenario, Latin America has been adopting LA to address specific educational challenges, including reducing quality disparities and dropout rates. However, the region confronts limitations for adoption, such as infrastructure, a lack of widespread data literacy, and regulatory constraints, all of which impede broader implementation. In this context, this special issue, titled “Applications of Learning Analytics in Latin America,” intends to present a comprehensive perspective on LA’s deployment across the continent, highlighting its current state and potential growth. In this editorial, we curate a selection of relevant papers, each delving into diverse facets of LA’s application within Latin American contexts. These papers exemplify practical implementations and discuss the implications and possible future trajectories for LA research, especially tailored for the Latin American academic community.

Geographical Disparities in the Management of Early-Stage Oropharyngeal Squamous Cell Carcinoma (OPSCC) in the United States (US)

Geographical Disparities in the Management of Early-Stage Oropharyngeal Squamous Cell Carcinoma (OPSCC) in the United States (US)

Research on the relationship between CEO career variety, digital knowledge base extension, and digital transformation in the context of digital merger and acquisition: The case of China's new generation of information technology firms.

This study examines the relationship between CEO career variety, digital knowledge base extension, and digital transformation in a digital M&A context. An empirical test was conducted using regression analysis with the digital M&A events of the new generation of information technology firms in China as the research sample. The results reveal that CEO career variety has a positive effect on digital transformation in the digital M&A context and that digital knowledge-base extension plays a mediating role. Moreover, the heterogeneity impact analysis indicated that the moderating effects of geographical distance, knowledge disparity, and cultural difference between target and acquirer firms on the above relationships vary greatly: geographical distance has a negative moderating effect, cultural difference has a positive moderating effect, and the moderating effects of both geographical distance and cultural difference are realized through mediating effects, but none of the moderating effects of knowledge disparity are significant.

Unraveling trends in schistosomiasis: deep learning insights into national control programs in China.

To achieve the ambitious goal of eliminating schistosome infections, the Chinese government has implemented diverse control strategies. This study explored the progress of the 2 most recent national schistosomiasis control programs in an endemic area along the Yangtze River in China. We obtained village-level parasitological data from cross-sectional surveys combined with environmental data in Anhui Province, China from 1997 to 2015. A convolutional neural network (CNN) based on a hierarchical integro-difference equation (IDE) framework (i.e., CNN-IDE) was used to model spatio-temporal variations in schistosomiasis. Two traditional models were also constructed for comparison with 2 evaluation indicators: the mean-squared prediction error (MSPE) and continuous ranked probability score (CRPS). The CNN-IDE model was the optimal model, with the lowest overall average MSPE of 0.04 and the CRPS of 0.19. From 1997 to 2011, the prevalence exhibited a notable trend: it increased steadily until peaking at 1.6 per 1,000 in 2005, then gradually declined, stabilizing at a lower rate of approximately 0.6 per 1,000 in 2006, and approaching zero by 2011. During this period, noticeable geographic disparities in schistosomiasis prevalence were observed; high-risk areas were initially dispersed, followed by contraction. Predictions for the period 2012 to 2015 demonstrated a consistent and uniform decrease. The proposed CNN-IDE model captured the intricate and evolving dynamics of schistosomiasis prevalence, offering a promising alternative for future risk modeling of the disease. The comprehensive strategy is expected to help diminish schistosomiasis infection, emphasizing the necessity to continue implementing this strategy.

Geographic disparities and predictors of COVID-19 vaccination in Missouri: a retrospective ecological study.

Limited information is available on geographic disparities of COVID-19 vaccination in Missouri and yet this information is essential for guiding efforts to improve vaccination coverage. Therefore, the objectives of this study were to (a) investigate geographic disparities in the proportion of the population vaccinated against COVID-19 in Missouri and (b) identify socioeconomic and demographic predictors of the identified disparities. The COVID-19 vaccination data for time period January 1 to December 31, 2021 were obtained from the Missouri Department of Health. County-level data on socioeconomic and demographic factors were downloaded from the 2020 American Community Survey. Proportions of county population vaccinated against COVID-19 were computed and displayed on choropleth maps. Global ordinary least square regression model and local geographically weighted regression model were used to identify predictors of proportions of COVID-19 vaccinated population. Counties located in eastern Missouri tended to have high proportions of COVID-19 vaccinated population while low proportions were observed in the southernmost part of the state. Counties with low proportions of population vaccinated against COVID-19 tended to have high percentages of Hispanic/Latino population (p = 0.046), individuals living below the poverty level (p = 0.049), and uninsured (p = 0.015) populations. The strength of association between proportion of COVID-19 vaccinated population and percentage of Hispanic/Latino population varied by geographic location. The study findings confirm geographic disparities of proportions of COVID-19 vaccinated population in Missouri. Study findings are useful for guiding programs geared at improving vaccination coverage and uptake by targeting resources to areas with low proportions of vaccinated individuals.