背景:COVID-19住院和死亡不成比例地影响着服务不足和少数群体,强调疫苗犹豫可能是这些人群中特别重要的公共卫生风险因素。
目的:表征服务不足的不同人群的COVID-19疫苗犹豫。
方法:少数民族和农村冠状病毒见解研究从加利福尼亚州的联邦合格健康中心招募了成年人(年龄≥18岁,n=3,735)的便利样本,中西部(伊利诺伊州/俄亥俄州),佛罗里达州和路易斯安那州,并在2020年11月至2021年4月收集了基线数据。疫苗犹豫状态被定义为对“你会接种冠状病毒疫苗吗,”这个问题的回答“没有”或“不确定”,如果可用?\"(\"是\"分类为毫不犹豫)。横断面描述性分析和逻辑回归模型检查了按年龄划分的疫苗犹豫率,性别,种族/民族,和地理。使用已发布的县级数据计算研究县的普通人群的预期疫苗犹豫估计。通过卡方检验评估了每个地区与人口统计学特征的粗略关联。主要影响模型包括年龄,性别,种族/民族,和地理区域来估计调整后的比值比(OR)和95%置信区间(CI)。在单独的模型中评估了地理和每个人口统计学特征之间的相互作用。
结果:最强的疫苗犹豫变异性是按地理区域划分的:在加利福尼亚州为28.3%(26.5-31.1),中西部地区36.1%(32.1-40.2),路易斯安那州59.1%(56.0-62.1),佛罗里达州67.9%(65.0-70.8)。一般人口的预期估计值较低:9.7%(加利福尼亚州),15.2%(中西部),18.2%(佛罗里达),和27.0%(路易斯安那州)。人口模式也因地理而异。发现了倒U型的年龄模式,在中西部地区25-34岁的人群中患病率最高(39.3%),佛罗里达州(79.5%,)和路易斯安那州(79.4%)(p<0.05)。在中西部,女性比男性更犹豫(36.5%vs23.9%),佛罗里达州(71.6%vs59.4%),和路易斯安那州(66.5%vs.46.4%)(p<0.05)。种族/种族差异在非西班牙裔黑人中最高(45.8%),在佛罗里达州中最高(69.3%),在中西部和路易斯安那州中最高(p<0.05)。主效应模型证实了U型与年龄的关联:与年龄25-34的关联最强,OR=2.28(1.74,2.99)。性别和种族/民族与该地区的统计交互作用显着,遵循粗略分析发现的模式。与女性性别的关联在佛罗里达州和路易斯安那州最强:与加利福尼亚州的男性相比,OR分别为7.83(5.94,10.33)和6.04(4.52,8.06),分别。与加州的非西班牙裔白人参与者相比,最强烈的协会被发现与西班牙裔在佛罗里达州和黑人在路易斯安那州:OR是11.18(7.01,17.85)和8.94(5.53,14.47),分别。然而,在加利福尼亚州和佛罗里达州观察到最强的种族/民族变异性:这些地区的种族/民族之间的OR变化为4.7倍和2倍,分别。
结论:这些发现强调了当地背景因素在驱动疫苗犹豫及其人口统计学模式中的作用。
COVID-19 hospitalizations and deaths disproportionately affect underserved and minority populations, emphasizing that vaccine hesitancy can be an especially important public health risk factor in these populations.
This study aims to characterize COVID-19 vaccine hesitancy in underserved diverse populations.
The Minority and Rural Coronavirus Insights Study (MRCIS) recruited a convenience sample of adults (age≥18, N=3735) from federally qualified health centers (FQHCs) in California, the Midwest (Illinois/Ohio), Florida, and Louisiana and collected baseline data in November 2020-April 2021. Vaccine hesitancy status was defined as a response of \"no\" or \"undecided\" to the question \"Would you get a coronavirus vaccine if it was available?\" (\"yes\" categorized as not hesitant). Cross-sectional descriptive analyses and logistic regression models examined vaccine hesitancy prevalence by age, gender, race/ethnicity, and geography. The expected vaccine hesitancy estimates for the general population were calculated for the study counties using published county-level data. Crude associations with demographic characteristics within each region were assessed using the chi-square test. The main effect model included age, gender, race/ethnicity, and geographical region to estimate adjusted odds ratios (ORs) and 95% CIs. Interactions between geography and each demographic characteristic were evaluated in separate models.
The strongest vaccine hesitancy variability was by geographic region: California, 27.8% (range 25.0%-30.6%); the Midwest, 31.4% (range 27.3%-35.4%); Louisiana, 59.1% (range 56.1%-62.1%); and Florida, 67.3% (range 64.3%-70.2%). The expected estimates for the general population were lower: 9.7% (California), 15.3% (Midwest), 18.2% (Florida), and 27.0% (Louisiana). The demographic patterns also varied by geography. An inverted U-shaped age pattern was found, with the highest prevalence among ages 25-34 years in Florida (n=88, 80.0%,) and Louisiana (n=54, 79.4%; P<.05). Females were more hesitant than males in the Midwest (n= 110, 36.4% vs n= 48, 23.5%), Florida (n=458, 71.6% vs n=195, 59.3%), and Louisiana (n= 425, 66.5% vs. n=172, 46.5%; P<.05). Racial/ethnic differences were found in California, with the highest prevalence among non-Hispanic Black participants (n=86, 45.5%), and in Florida, with the highest among Hispanic (n=567, 69.3%) participants (P<.05), but not in the Midwest and Louisiana. The main effect model confirmed the U-shaped association with age: strongest association with age 25-34 years (OR 2.29, 95% CI 1.74-3.01). Statistical interactions of gender and race/ethnicity with the region were significant, following the pattern found by the crude analysis. Compared to males in California, the associations with the female gender were strongest in Florida (OR=7.88, 95% CI 5.96-10.41) and Louisiana (OR=6.09, 95% CI 4.55-8.14). Compared to non-Hispanic White participants in California, the strongest associations were found with being Hispanic in Florida (OR=11.18, 95% CI 7.01-17.85) and Black in Louisiana (OR=8.94, 95% CI 5.53-14.47). However, the strongest race/ethnicity variability was observed within California and Florida: the ORs varied 4.6- and 2-fold between racial/ethnic groups in these regions, respectively.
These findings highlight the role of local contextual factors in driving vaccine hesitancy and its demographic patterns.