Mediators of Racial Differences in COVID-19 Vaccine Acceptance and Uptake: A Cohort Study in Detroit, MI.
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SUBMITTER: Wagner AL
PROVIDER: S-EPMC8778664 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Vaccines are one of the most successful tools for protecting the public's health. However, widespread vaccine hesitancy in the Southern United States is preventing effective mitigation of the current COVID-19 pandemic. The purpose of this study was to assess COVID-19 vaccine acceptance among adults living in a largely rural Southern state. This cross-sectional study collected data from 1,164 Arkansas residents between October 3 and October 17, 2020 using random digit dialing. The primary outcome was a multidimensional COVID-19 vaccine acceptance measure with scores between -3 to +3. The full COVID-19 vaccine acceptance scale was measured along with perceived vaccine safety, effectiveness, acceptance, value, and legitimacy subscales. Statistical analyses were conducted using multivariable linear regression. Results indicated Black participants had the lowest overall vaccine acceptance (0.5) compared to White participants (1.2). Hispanic participants had the highest scores (1.4). In adjusted models, Black participants had 0.81 points lower acceptance than White participants, and Hispanic participants had 0.35 points higher acceptance. Hispanic participants had the highest scores for all five vaccine acceptance subscales, relatively equivalent to White participants. Black participants had consistently lower scores, especially perceived vaccine safety (mean -0.2, SD 0.1). In conclusion, the lowest vaccine acceptance rates were among Black participants particularly on perceived vaccine safety. While Black participants had the lowest acceptance scores, Hispanic participants had the highest. This variability shows the value of a multidimensional vaccine acceptance measure to inform COVID-19 vaccination campaign strategies.
| S-EPMC10194941 | biostudies-literature
Project description:BackgroundRacial and ethnic minorities have been disproportionately impacted by COVID-19. In the initial phase of population-based vaccination in the United States (U.S.) and United Kingdom (U.K.), vaccine hesitancy and limited access may result in disparities in uptake.MethodsWe performed a cohort study among U.S. and U.K. participants in the smartphone-based COVID Symptom Study (March 24, 2020-February 16, 2021). We used logistic regression to estimate odds ratios (ORs) of COVID-19 vaccine hesitancy (unsure/not willing) and receipt.ResultsIn the U.S. ( n =87,388), compared to White non-Hispanic participants, the multivariable ORs of vaccine hesitancy were 3.15 (95% CI: 2.86 to 3.47) for Black participants, 1.42 (1.28 to 1.58) for Hispanic participants, 1.34 (1.18 to 1.52) for Asian participants, and 2.02 (1.70 to 2.39) for participants reporting more than one race/other. In the U.K. ( n =1,254,294), racial and ethnic minorities had similarly elevated hesitancy: compared to White participants, their corresponding ORs were 2.84 (95% CI: 2.69 to 2.99) for Black participants, 1.66 (1.57 to 1.76) for South Asian participants, 1.84 (1.70 to 1.98) for Middle East/East Asian participants, and 1.48 (1.39 to 1.57) for participants reporting more than one race/other. Among U.S. participants, the OR of vaccine receipt was 0.71 (0.64 to 0.79) for Black participants, a disparity that persisted among individuals who specifically endorsed a willingness to obtain a vaccine. In contrast, disparities in uptake were not observed in the U.K.ConclusionsCOVID-19 vaccine hesitancy was greater among racial and ethnic minorities, and Black participants living in the U.S. were less likely to receive a vaccine than White participants. Lower uptake among Black participants in the U.S. during the initial vaccine rollout is attributable to both hesitancy and disparities in access.
| S-EPMC7924296 | biostudies-literature
Project description:Given high COVID-19 infection and mortality ratesamong racial minorities in the US and their higher rates of religiosity, it is important to examine how the intersection of race and religion influences perceptions of COVID-19 vaccinations.Data for this study come from online surveys conducted in twelve congregations between October and December 2020 (N = 1,609). Based on logistic regression analyses, this study demonstrates a severe disparity of 24 percentage points (95% confidence interval 0.14-0.33) in anticipated COVID-19 vaccine acceptance between African Americans and White Americans, even when controlling for trust in COVID-19 information from scientists and levels of worrying about COVID-19 as well as religiosity and demographic factors. Religiosity is negatively associated with COVID-19 vaccine acceptance across racial groups. The findings suggest that the intersection of race and religion should be considered when designing immunization programs, for instance by fostering collaborations and dialogue with faith leaders of racial minority congregations.
| S-EPMC8446822 | biostudies-literature
Project description:BackgroundCovid-19 vaccination is the main strategy to reduce SARS-CoV-2 transmission, mortality and morbidity. This study aimed to examine sociodemographic differences in Covid-19 vaccine uptake among all individuals invited for Covid-19 vaccination in Denmark.MethodsThis study was designed as a nationwide register-based cohort study. The study population included all Danish residents aged 12 years or above in Denmark between December 27, 2020 and October 20, 2021. Individuals who died during the study period before receiving an invitation for Covid-19 vaccination were excluded. Associations between sociodemographic factors and Covid-19 vaccination uptake were analyzed using logistic regression models adjusting for age, sex, immigration status, educational level, disposable income and history of SARS-CoV-2 infection.ResultsThe study population included 5,164,558 individuals. The overall vaccination coverage was 87.1% by October 20, 2021. In the full adjusted logistic regression models, the highest ORs for non-vaccination were observed among individuals aged 12-24 years (OR: 8.99 (95% CI: 8.76-9.23)), descendants of non-western immigrants (OR: 5.26 (95% CI: 5.18-5.33)), individuals who never had a PCR-test performed (OR: 2.93 (95% CI: 2.90-2.96)), individuals with primary school as highest completed educational level (OR: 2.87 (95% CI: 2.83-2.91)) and individuals with disposable income < 33,605 EUR (OR: 3.72 (95% CI: 3.52-3.93)).ConclusionOverall, the Covid-19 vaccine uptake was high in Denmark. However, large sociodemographic differences in the vaccine uptake exist. The youngest age groups had the lowest vaccination coverage. Furthermore, the impact of the sociodemographic factors was more pronounced in the youngest age groups. The identified determinants may be used to design policies to help maximize the vaccination coverage.
| S-EPMC9955526 | biostudies-literature
Project description:BackgroundPrevious research suggests that racial and ethnic minority groups especially Black Americans showed stronger COVID-19 vaccine hesitancy and resistance, which may result from a lack of trust toward the government and vaccine manufacturers, among other sociodemographic and health factors.ObjectivesThe current study explored potential social and economic, clinical, and psychological factors that may have mediated racial and ethnic disparities in COVID-19 vaccine uptake among US adults.MethodsA sample of 6078 US individuals was selected from a national longitudinal survey administered in 2020-2021. Baseline characteristics were collected in December 2020, and respondents were followed up to July 2021. Racial and ethnic disparities in time to vaccine initiation and completion (based on a 2-dose regimen) were first assessed with the Kaplan-Meier Curve and log-rank test, and then explored with the Cox proportional hazards model adjusting for potential time-varying mediators, such as education, income, marital status, chronic health conditions, trust in vaccine development and approval processes, and perceived risk of infection.ResultsPrior to mediator adjustment, Black and Hispanic Americans had slower vaccine initiation and completion than Asian Americans and Pacific Islanders and White Americans (p's < 0.0001). After accounting for the mediators, there were no significant differences in vaccine initiation or completion between each minoritized group as compared to White Americans. Education, household income, marital status, chronic health conditions, trust, and perceived infection risk were potential mediators.ConclusionRacial and ethnic disparities in COVID-19 vaccine uptake were mediated through social and economic conditions, psychological influences, and chronic health conditions. To address the racial and ethnic inequity in vaccination, it is important to target the social, economic, and psychological forces behind it.
| S-EPMC9974364 | biostudies-literature
Project description:BackgroundCOVID-19 vaccine acceptance is important in ensuring the widespread vaccination of the population to achieve herd immunity. Establishing the acceptance of vaccines among healthcare workers, who play a vital role in an immunization program's success, is important. The aim of this study was to assess the influence of social trust and demographic factors on COVID-19 vaccine acceptance among healthcare workers.MethodsA cross-sectional survey utilizing an electronic questionnaire inquiring about COVID-19 vaccine uptake, preferences, and concerns was distributed via e-mail to 1,351 North Central Regional Health Authority (NCRHA) healthcare workers of the following categories: medical practitioners, nursing personnel, veterinary surgeons, medical interns, dental interns, paramedics, and pharmacists. These professions were selected as they were granted power to administer COVID-19 vaccines during the period of public emergency by the President of Trinidad and Tobago and were therefore likely to be NCRHA healthcare workers directly involved in vaccine administration services. Bivariate analysis using Chi-squared analysis of association was used to determine the association between the respondents' characteristics and the acceptance of the vaccine and the association between vaccine acceptance among healthcare workers and trust. The association between the acceptance of the COVID-19 vaccines and healthcare workers' characteristics and trust was established using multinomial logistic regression.ResultsA total of 584 healthcare workers took part in the study, and 1.4% showed unwillingness to receive the COVID-19 vaccine. The study indicates that age, profession, trust in international public health organizations, and trust in other healthcare providers predict the uptake of COVID-19 vaccines among healthcare workers, with younger age groups and the nursing profession associated with an unwillingness to accept the vaccine. Gender of the healthcare workers does not predict vaccine acceptance. Conclusions and relevance: efforts towards enhanced vaccine acceptance among healthcare workers should take into consideration age, profession, and the trust in international organizations and other healthcare providers. Sensitization programs aimed at informing and creating awareness among healthcare workers about the COVID-19 vaccines should be age-specific as well as occupation-based.
| S-EPMC9481343 | biostudies-literature
Project description:COVID-19 vaccines have been available for over a year, yet 26% of U.S. young adults remain unvaccinated. This study examines racial and ethnic disparities in young adult vaccine hesitancy and attitudes/beliefs that mediate disparities in vaccine hesitancy. Young adults (n = 2041;Mean[SD]:21.3[0.7] years-old) from a Los Angeles, CA, USA cohort were surveyed online in January-May 2021 and classified as vaccine hesitant (those who reported "Not at all likely"/"Not very likely" /"Slightly likely" to get vaccinated) versus non-hesitant (those who reported "Moderately likely"/"Very likely"/"Definitely likely" to get vaccinated or already vaccinated). Multivariable logistic regression was performed to examine racial/ethnic disparities in vaccine hesitancy. Factor analysis was conducted to create three subscales toward vaccination: positive, negative, and lack-of-access beliefs. Mediation analyses were performed to assess pathways from attitude/belief subscales to racial disparities in vaccine hesitancy. Overall 33.0% of respondents reported vaccine hesitancy. Black vs. White young adults had a higher prevalence of vaccine hesitancy (AOR[95%CI] = 4.3[2.4-7.8]), and Asians vs. Whites had a lower prevalence (AOR[95%CI] = 0.5[0.3-0.8]). Mediators explained 90% of the Black (vs. White) disparity in vaccine hesitancy, including significant indirect effects through positive belief-reducing (β = 0.23,p < .001) and negative belief-enhancing (β = 0.02,p = .04) effects. About 81% of the Asian (vs. White) disparity in vaccine hesitancy was explained by the three combined subscales, including significant positive belief-reducing (β = -0.18,p < .001) indirect effect. Substantial racial and ethnic disparities in young adult COVID-19 vaccine hesitancy were found, which were mediated by differences in attitudes and beliefs toward vaccination. Targeted education campaigns and messages are needed to promote equitable utilization of the effective vaccine.
| S-EPMC9072749 | biostudies-literature
Project description:ObjectiveThe objective of this study was to evaluate the acceptance and uptake of COVID-19 vaccines in rural Bangladesh.DesignThis was a cross-sectional study conducted between June and November 2021.SettingThis study was conducted in rural Bangladesh.ParticipantsPeople older than 18 years of age, not pregnant and no history of surgery for the last 3 months were eligible to participate.Primary and secondary outcomesThe primary outcomes were proportions of COVID-19 vaccine acceptance and roll-out participation among the rural population. The secondary outcome was identification of correlates which contributed to COVID-19 vaccine acceptance and roll-out participation. Χ2 tests and multivariable logistic regression analyses were performed to identify relevant correlates such as sociodemographic factors, clinical conditions and COVID-19-related factors.ResultsA total of 1603 participants were enrolled. The overall COVID-19 vaccine acceptance was very high (1521/1601, 95%), and half of the participants received at least one dose of the COVID-19 vaccine. Majority of participants wanted to keep others safe (89%) and agreed to the benefits of COVID-19 vaccines (88%). To fulfil the requirement of online registration for the vaccine at the time, 62% of participants had to visit an internet café and only 31% downloaded the app. Over half (54%) of participants were unaware of countries they knew and trust to produce the COVID-19 vaccine. Increased age, being housewives, underweight and undergraduate education level were associated with vaccine acceptance, while being female, increased age and being overweight/obese were associated with vaccine uptake. Trust in the health department and practical knowledge regarding COVID-19 vaccines were positively associated with both vaccine acceptance and uptake.ConclusionThis study found a very high COVID-19 vaccine acceptance in rural Bangladesh. Policymakers should support interventions aimed at increasing vaccine and general health literacy and ensure ongoing vaccine supply and improvement of infrastructure in rural areas.
| S-EPMC9748515 | biostudies-literature
Project description:BackgroundNew Zealand's Immunisation Programme is an important pillar in the war against COVID-19, making high vaccine uptake essential. This study sought to: (1) identify potential vaccine uptake rates among New Zealanders prior to programme rollout; (2) understand reasons for unlikelihood/likelihood of vaccine uptake; and, (3) explore sociodemographic differences in risk of and reasons for vaccine hesitancy.MethodsData were collected in March 2021 (n = 1,284) via a web-based survey. Respondents were a diverse sample of New Zealanders who were part of a large, pre-existing social research sampling frame. Multinomial and logit regressions were estimated to examine sociodemographic predictors of vaccine hesitancy and reasons for likelihood/hesitancy.FindingsOverall, 70% reported they would likely take the vaccine once available (i.e., very likely or somewhat likely). Being younger and less educated were correlated with greater vaccine hesitancy risk (i.e., very unlikely, somewhat likely, or unsure). Women were more likely than men to say they were unsure (Relative Risk Ratio = 1.60) vs. either likely or unlikely and to identify concerns regarding personal health, such as potential side effects, as a reason. Men identified concerns surrounding trust in vaccines and the perceived exaggerated risk of COVID-19 to them and the population.InterpretationAlthough a majority intend to take the COVID-19 vaccine once available, a sizeable minority who were more likely to be young, female, and less educated, were unsure about or unlikely to get the vaccine, primarily due to perceptions of unknown future side effects. Ethnicity was not statistically associated with vaccine hesitancy, suggesting that public health efforts aimed at increasing vaccine acceptance among Māori and Pacific peoples-subgroups most at-risk of COVID-19 infection and morbidity-should focus on inequities in health care access to increase uptake.
| S-EPMC8342930 | biostudies-literature
Project description:SARS-CoV-2 vaccines are useful tools to combat the Coronavirus Disease 2019 (COVID-19) pandemic, but vaccine reluctance threatens these vaccines' effectiveness. To address COVID-19 vaccine reluctance and ensure equitable distribution, understanding the extent of and factors associated with vaccine acceptance and uptake is critical. We report the results of a large nationwide study in the US conducted December 2020-May 2021 of 36,711 users from COVID-19-focused smartphone-based app How We Feel on their willingness to receive a COVID-19 vaccine. We identified sociodemographic and behavioral factors that were associated with COVID-19 vaccine acceptance and uptake, and we found several vulnerable groups at increased risk of COVID-19 burden, morbidity, and mortality were more likely to be reluctant to accept a vaccine and had lower rates of vaccination. Our findings highlight specific populations in which targeted efforts to develop education and outreach programs are needed to overcome poor vaccine acceptance and improve equitable access, diversity, and inclusion in the national response to COVID-19.
| S-EPMC10209066 | biostudies-literature