Cluster analysis reveals three main patterns of beliefs and intention with respect to SARS-CoV-2 vaccination in patients with autoimmune and inflammatory diseases

Abstract

Introduction Given the COVID19 pandemic, it is crucial to understand the underlying behavioral determinants of SARS-CoV-2 vaccine hesitancy in patients with autoimmune or inflammatory rheumatic diseases AIIRD. We aimed to analyze patterns of behaviors regarding SARS-CoV-2 vaccination in AIIRD patients, as a mean to identify pragmatic actions to increase vaccine coverage in this population. Methods Data of 1258 AIIRD patients were analyzed using univariate and multivariate logistic regression models, to identify variables associated independently with the willingness to get vaccinated against SARS-CoV-2. Subsets of patients showing similar behaviors towards SARS-CoV-2 vaccination were characterized using cluster analysis. Results Hierarchical cluster analysis identified 3 distinct clusters of AIIRD patients. Three predominant patients’ behavior towards SARS-COV-2 vaccination: ‘voluntary’, ‘hesitant’ and ‘suspicious’ were identified. While vaccine willingness was significantly different across the 3 clusters p< 0.0001, there was no difference regarding the fear to get COVID-19 p= 0.11, the presence of co-morbidities p= 0.23, the use of glucocorticoids p= 0.21 or the immunocompromised status p= 0.63. However, patients from cluster #3 ‘suspicious’ were significantly more concerned about vaccination, the use of a new vaccine technology, the lack of hindsight regarding COVID vaccination and potential financial links with pharmaceutical companies p< 0.0001 in all than in the other 2 clusters. Discussion Importantly, the differences between patients’ behaviors are not related to the fear of getting COVID-19 or to any state of frailty, but point out to specific concerns about vaccination. This study may serve as a basis for improved communication, to increase COVID-19 vaccine coverage in AIIRD patients.

COVID-19 vaccine safety and nocebo-prone associated hesitancy in patients with systemic rheumatic diseases: a cross-sectional study

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