Patterns in COVID-19 Vaccination Coverage, by Social Vulnerability and Urbanicity — United States, December 14, 2020–May 1, 2021

Abstract

Disparities in vaccination coverage by social vulnerability, defined as social and structural factors associated with adverse health outcomes, were noted during the first 2.5 months of the U.S. COVID-19 vaccination campaign, which began during mid-December 2020 (1). As vaccine eligibility and availability continue to expand, assuring equitable coverage for disproportionately affected communities remains a priority. CDC examined COVID-19 vaccine administration and 2018 CDC social vulnerability index (SVI) data to ascertain whether inequities in COVID-19 vaccination coverage with respect to county-level SVI have persisted, overall and by urbanicity. Vaccination coverage was defined as the number of persons aged ≥18 years (adults) who had received ≥1 dose of any Food and Drug Administration (FDA)-authorized COVID-19 vaccine divided by the total adult population in a specified SVI category. † SVI was examined overall and by its four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation). Counties were categorized into SVI quartiles, in which quartile 1 (Q1) represented the lowest level of vulnerability and quartile 4 (Q4), the highest. Trends in vaccination coverage were assessed by SVI quartile and urbanicity, which was categorized as large central metropolitan, large fringe metropolitan (areas surrounding large cities, e.g., suburban), medium and small metropolitan, and nonmetropolitan counties. § During December 14, 2020-May 1, 2021, disparities in vaccination coverage by SVI increased, especially in large † Vaccination coverage was calculated by summing the number of vaccinated adults in each SVI category and dividing by the total adult population in the specified SVI category. Population denominators were obtained from the U.S. Census Bureau. § Urbanicity was defined on the basis of the 2013 National Center for Health Statistics urban-rural classification scheme. For this analysis, categories included large central metropolitan counties, large fringe metropolitan counties, medium and small metropolitan counties, and nonmetropolitan counties. Large central metropolitan counties are counties in metropolitan statistical areas (MSAs) with ≥1 million population; large fringe metropolitan counties are counties in MSAs with ≥1 million population that did not qualify as large central metropolitan counties; medium metropolitan counties are counties in MSAs with populations of 250,000-999,999; small metropolitan counties are counties in MSAs with populations <250,000; nonmetropolitan counties are all micropolitan and noncore counties. https://www.cdc.gov/nchs/data_access/urban_rural.htm fringe metropolitan (e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage was lower among adults living in counties with the highest overall SVI; differences were most pronounced in large fringe metropolitan (Q4 coverage = 45.0% versus Q1 coverage = 61.7%) and nonmetropolitan (Q4 = 40.6% versus Q1 = 52.9%) counties. ...

COVID-19 Vaccination Coverage Among Adults — United States, December 14, 2020–May 22, 2021

“…Equitable access to vaccination is critical to improve coverage for persons of all ages who live in communities that are less urban ( 6 ), have higher social vulnerabilities ( 1 , 7 ), and have higher percentages of social determinants of poor health ( 8 ). In a report that pooled findings from two representative surveys of U.S. adults aged 18–39 years, only one half (51.8%) reported that they had been or were planning to be vaccinated, whereas 24.9% reported that they probably or definitely would not be vaccinated, and 23.2% reported that they would probably be vaccinated or were unsure if they would be vaccinated ( 9 ).…”

“…Second dose completion was defined as the percentage of persons who received the second dose of a 2-dose vaccine at any point, among those who had received at least 1 dose of a 2-dose vaccine. *** Absolute differences in coverage by age were calculated during three periods selected to represent general shifts in targeted subpopulations, supply, and policy over the course of the COVID-19 vaccination program ††† ( 1 ): December 14, 2020–January 23, 2021; January 24, 2021–March 20, 2021; and March 21, 2021–May 22, 2021.…”

Socioeconomic variation in characteristics, outcomes, and healthcare utilization of COVID-19 patients in New York City

“…Taken together, the findings of this study make clear that ensuring equitable access to COVID-19 vaccination should be a priority for the U.S. COVID-19 vaccination program. Early evidence suggests that vaccination has been lower among residents of counties with disadvantaged social conditions [57,58]. This may be due to limited vaccination supply, difficulty taking time off from work, or higher rates of mistrust of the medical system and vaccine hesitancy [59].…”

COVID-19 Vaccine Coverage Index: Identifying barriers to COVID-19 vaccine uptake across U.S. counties

“…28 The CDC recently published its findings that most socially vulnerable communities have vaccinated 11% fewer adults than least vulnerable counties. 29 Many have focused on the role of vaccine hesitancy in explaining heterogeneity in vaccine uptake 8,30 , however, our findings suggest that there are additional systemic barriers that must be addressed alongside. The CVAC offers policymakers a broader picture of supply-and demandside factors to overcome barriers within their jurisdictions.…”