Abstract：
This study reviews the impact of eligibility policies in the early rollout of the COVID-19 vaccine on coverage and probable outcomes, with a focus on New York City. We conducted a retrospective ecological study assessing age 65+, area-level income, vaccination coverage, and COVID-19 mortality rates, using linked Census Bureau data and New York City Health administrative data aggregated at the level of modified zip code tabulation areas (MODZCTA). The population for this study was all individuals in 177 MODZCTA in New York City. Population data were obtained from Census Bureau and New York City Health administrative data. The total mortality rate was examined through an ordinary least squares (OLS) regression model, using area-level wealth, the proportion of the population aged 65 and above, and the vaccination rate among this age group as predictors. Low-income areas with high proportions of older people demonstrated lower coverage rates (mean vaccination rate 52.8%; maximum coverage 67.9%) than wealthier areas (mean vaccination rate 74.6%; maximum coverage 99% in the wealthiest quintile) in the first 3 months of vaccine rollout and higher mortality over the year. Despite vaccine shortages, many younger people accessed vaccines ahead of schedule, particularly in high-income areas (mean coverage rate 60% among those 45-64 years in the wealthiest quintile). A vaccine program that prioritized those at greatest risk of COVID-19-associated morbidity and mortality would have prevented more deaths than the strategy that was implemented. When rolling out a new vaccine, policymakers must account for local contexts and conditions of high-risk population groups. If New York had focused limited vaccine supply on low-income areas with high proportions of residents 65 or older, overall mortality might have been lower.
摘要：
这项研究回顾了早期推出COVID-19疫苗的资格政策对覆盖率和可能结果的影响，专注于纽约市。我们进行了一项回顾性生态研究，评估年龄65岁以上，地区一级收入，疫苗接种覆盖率，和COVID-19死亡率，使用链接的人口普查局数据和纽约市卫生行政数据，这些数据在修改后的邮政编码制表区（MODZCTA）级别汇总。这项研究的人群是纽约市177个MODZCTA中的所有个体。人口数据来自人口普查局和纽约市卫生行政数据。通过普通最小二乘(OLS)回归模型检查总死亡率，利用地区层面的财富，65岁及以上人口比例，和该年龄组的疫苗接种率作为预测因子。在疫苗推出的前3个月，老年人比例高的低收入地区的覆盖率（平均疫苗接种率为52.8%；最大覆盖率为67.9%）低于较富裕地区（平均疫苗接种率为74.6%；最富有的五分之一人群的最大覆盖率为99%），全年死亡率较高。尽管疫苗短缺，许多年轻人提前接种疫苗，特别是在高收入地区(在最富有的五分之一人群中，45-64岁的平均覆盖率为60%)。优先考虑那些与COVID-19相关的发病率和死亡率风险最高的人群的疫苗计划，将比实施的战略预防更多的死亡。当推出新疫苗时，政策制定者必须考虑当地高危人群的背景和条件。如果纽约将有限的疫苗供应集中在65岁或65岁以上居民比例高的低收入地区，总死亡率可能较低.
