Inequities in coronavirus disease 2019 (COVID-19) Vaccination Rates Among Adolescents in Massachusetts: A Cross-sectional Study

Abstract

Background The COVID-19 pandemic has disproportionately affected more socioeconomically disadvantaged persons and areas. We sought to determine how certain sociodemographic factors were correlated to adolescents’ COVID-19 vaccination rates in towns and cities (“communities”) in the Commonwealth of Massachusetts. Methods Data on COVID-19 vaccination rates were obtained over a 20-week period from March 30, 2021 to August 10, 2021. Communities’ adolescent (ages 12-19) vaccination rates were compared across quintiles of community-level income, COVID-19 case rate, and proportion of non-Hispanic Black or Hispanic individuals. Other variables included population density and earlier COVID-19 vaccination rates of adolescents and adults, averaged from March 30 to May 11 to determine their effects on vaccination rates on August 10. Linear and logistic regression was used to estimate individual effects of variables on adolescent vaccination rates. Results Higher median household income, lower proportion of Black or Hispanic individuals, higher early adolescent COVID-19 vaccination rates, and higher early adult COVID-19 vaccination rates were associated with higher later adolescent COVID-19 vaccination rates. Income per $10,000 (adjusted odds ratio=1.01 [95% confidence interval=1.01-1.02]), proportion of Hispanic individuals (1.33 [1.13-1.56]), early adolescent COVID-19 vaccination rates (5.28 [4.67-5.96]), and early adult COVID-19 vaccination rates (2.31 [2.02-2.64]) were associated with higher adolescent COVID-19 vaccination on August 10, while proportion of Black individuals approached significance (1.26 [0.98-1.61]). Conclusions Vaccination efforts for adolescents in Massachusetts should focus on boosting vaccination rates early in communities with the lowest incomes and greatest proportion of Hispanic individuals and consider targeting communities with a greater proportion of Black individuals.

Systematic review of socioeconomic factors and COVID‐19 in children and adolescents

“…Parents with lower SES and belonging to minority groups were less likely to vaccinate their children than their more privileged counterparts. [18][19][20][21][22] This phenomenon has been observed also for other types of vaccines. Studies on children immunisation against diseases such as measles, mumps and rubella (MMR-vaccine) and tetanus, diphtheria and pertussis (DPT-vaccine), indicated that children vaccination status depended, among other things, of parental education, household income and parents being born in another country.…”

“…Furthermore, one of the studies showed that as income levels decreased, the likelihood of adolescent vaccination correspondingly declined 20 . Demographic regions characterised by higher poverty rates and lower SES had a higher proportion of Black and Hispanic individuals, and thus children from these ethnic backgrounds were less likely to be vaccinated than White or Asian children 18,20,21 . Additionally, children with parents with a master's degree exhibited a 47% higher probability of vaccination, compared to those born to parents with lower education levels 18 …”

“…Three studies from the United States showed that child vaccination rates were associated with income and race/ethnicity. 18,20,21 Children and adolescents from low-income households had lower child vaccination rates compared to their counterparts from higher income households. Furthermore, one of the studies showed that as income levels decreased, the likelihood of adolescent vaccination correspondingly declined.…”

“…We identified five articles that studied the association between COVID-vaccination in children and socioeconomic variables (see Table 4). [18][19][20][21][22] F I G U R E 1 PRISMA flow chart. *FHI/ Indseth.…”

Social Determinants of COVID-19 Vaccination Rates: A Time-Constrained Multiple Mediation Analysis

“…Third, this study showed that high-income counties have higher vaccination rates. A previous study also indicated that county-level income was positively associated with COVID-19 vaccination rates [26]. Fourth, counties with a higher percentage of residents with limited English proficiency had higher vaccination rates (regression coefficient 0.24).…”