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De Guzman C, Thomas CA, Wiwanto L, Hu D, Henriquez-Rivera J, Gage L, Perreault JC, Harris E, Rastas C, McCormick D, Gaffney A. Health Care Access and COVID-19 Vaccination in the United States: A Cross-Sectional Analysis. Med Care 2024; 62:380-387. [PMID: 38728678 DOI: 10.1097/mlr.0000000000002005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
BACKGROUND Although federal legislation made COVID-19 vaccines free, inequities in access to medical care may affect vaccine uptake. OBJECTIVE To assess whether health care access was associated with uptake and timeliness of COVID-19 vaccination in the United States. DESIGN A cross-sectional study. SETTING 2021 National Health Interview Survey (Q2-Q4). SUBJECTS In all, 21,532 adults aged≥18 were included in the study. MEASURES Exposures included 4 metrics of health care access: health insurance, having an established place for medical care, having a physician visit within the past year, and medical care affordability. Outcomes included receipt of 1 or more COVID-19 vaccines and receipt of a first vaccine within 6 months of vaccine availability. We examined the association between each health care access metric and outcome using logistic regression, unadjusted and adjusted for demographic, geographic, and socioeconomic covariates. RESULTS In unadjusted analyses, each metric of health care access was associated with the uptake of COVID-19 vaccination and (among those vaccinated) early vaccination. In adjusted analyses, having health coverage (adjusted odds ratio [AOR] 1.60; 95% CI: 1.39, 1.84), a usual place of care (AOR 1.58; 95% CI: 1.42, 1.75), and a doctor visit within the past year (AOR 1.45, 95% CI: 1.31, 1.62) remained associated with higher rates of COVID-19 vaccination. Only having a usual place of care was associated with early vaccine uptake in adjusted analyses. LIMITATIONS Receipt of COVID-19 vaccination was self-reported. CONCLUSIONS Several metrics of health care access are associated with the uptake of COVID-19 vaccines. Policies that achieve universal coverage, and facilitate long-term relationships with trusted providers, may be an important component of pandemic responses.
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Affiliation(s)
- Charles De Guzman
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Chloe A Thomas
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Lynn Wiwanto
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Dier Hu
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jose Henriquez-Rivera
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Lily Gage
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jaclyn C Perreault
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Emily Harris
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Charlotte Rastas
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Adam Gaffney
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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Chen CX, Cabugao P, Nguyen M, Villegas D, Batra K, Singh A, Kioka M. Comparing demographics, clinical characteristics, and hospital outcomes by vaccine uptake status: A single-institution cross-sectional study. Medicine (Baltimore) 2023; 102:e35421. [PMID: 37800810 PMCID: PMC10553062 DOI: 10.1097/md.0000000000035421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023] Open
Abstract
Vaccination against Coronavirus disease 2019 (COVID-19) has been the cornerstone of reducing morbidity and mortality of this disease, as it has been shown to decrease the risk of viral transmission, severity of disease, hospitalization, and intubation. However, true understanding of its impact is skewed by heterogeneous vaccine administration due to lack of equitable access, vaccine hesitancy, and varying social determinants of health. Therefore, this study aims to identify groups that are less likely to be vaccinated and understand whether the resultant differences in vaccination rates affect morbidity and mortality in socially marginalized COVID-19 patients. A retrospective cohort analysis was performed on a randomized and stratified population of 939 COVID-19 patients from January 2021 to December 2021. Bivariate analysis and logistic regression were used to assess demographic and clinical characteristic trends in unvaccinated, partially vaccinated, and fully vaccinated groups. No one age (P = .21), gender (P = .9), race (P = .12), ethnicity (P = .09), or health insurance status (P = .13) group was more vaccinated than the other. Similarly, no subgroup was at increased odds of intubation (P = .08) or death. However, patients with all categories of comorbidities including cardiopulmonary disease (P = <.001, effect size .17), renal disease (P = <.001, effect size 0.138), metabolic disease (P = .04), and immunocompromised (P = .01) states were found to have significantly higher vaccination rates. Our study also shows that full vaccination protects against mortality and decreases the odds of intubation by 55% (adjusted odds ratio = 0.453, P value = .015) compared to no vaccination or partial vaccination. Findings from this study show an encouraging trend that sicker patients had higher rates of vaccination against COVID-19. This trend highlights the need for further identification of motivators that may be applied to vaccine-hesitant populations, which can help guide population-level policy, increase vaccination campaign yield, and reach for health equity.
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Affiliation(s)
- Claire Xinning Chen
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Paul Cabugao
- Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Max Nguyen
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Daniel Villegas
- Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Kavita Batra
- Office of Research, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
- Department of Medical Education and Office of Academic Affairs, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Aditi Singh
- Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
| | - Mutsumi Kioka
- Department of Pulmonary and Critical Care Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, NV, USA
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Gaffney A, Woolhandler S, Bor J, McCormick D, Himmelstein DU. Community Health, Health Care Access, And COVID-19 Booster Uptake In Massachusetts. Health Aff (Millwood) 2023; 42:268-276. [PMID: 36745834 DOI: 10.1377/hlthaff.2022.00835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Booster vaccination offers vital protection against COVID-19, particularly for communities in which many people have chronic conditions. Although vaccination has been widely and freely available, people who have experienced barriers to care might be deterred from being vaccinated. We examined the relationship between COVID-19 booster uptake and small area-level demographics, chronic disease prevalence, and measures of health care access in 462 Massachusetts communities during the period September 2021-April 2022. Unadjusted analyses found that booster uptake was higher in older and wealthier areas, lower in areas with more Hispanic and Black residents, and lower in areas with a high prevalence of chronic conditions. In both unadjusted and adjusted analyses, uptake was lower in communities with more uninsured residents and those in which fewer residents received routine medical check-ups. Adjusted analyses found that areas with more vaccine providers and primary care physicians had higher booster uptake, but this association was not significant in unadjusted analyses. Results suggest a need for innovative outreach efforts, as well as structural changes such as expansion of health care coverage and universal access to care to mitigate the inequitable burden of COVID-19.
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Affiliation(s)
- Adam Gaffney
- Adam Gaffney , Harvard University and Cambridge Health Alliance, Cambridge, Massachusetts
| | - Steffie Woolhandler
- Steffie Woolhandler, City University of New York, New York, New York; Harvard University; and Cambridge Health Alliance
| | - Jacob Bor
- Jacob Bor, Boston University, Boston, Massachusetts
| | - Danny McCormick
- Danny McCormick, Harvard University and Cambridge Health Alliance
| | - David U Himmelstein
- David U. Himmelstein, City University of New York, Harvard University, and Cambridge Health Alliance
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Gaffney A, Himmelstein DU, Dickman S, McCormick D, Woolhandler S. Uptake and Equity in Influenza Vaccination Among Veterans with VA Coverage, Veterans Without VA Coverage, and Non-Veterans in the USA, 2019-2020. J Gen Intern Med 2022; 38:1152-1159. [PMID: 36163527 PMCID: PMC9512990 DOI: 10.1007/s11606-022-07797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Vaccination is a primary method of reducing the burden of influenza, yet uptake is neither optimal nor equitable. Single-tier, primary care-oriented health systems may have an advantage in the efficiency and equity of vaccination. OBJECTIVE To assess the association of Veterans' Health Administration (VA) coverage with influenza vaccine uptake and disparities. DESIGN Cross-sectional. PARTICIPANTS Adult respondents to the 2019-2020 National Health Interview Survey. MAIN MEASURES We examined influenza vaccination rates, and racial/ethnic and income-based vaccination disparities, among veterans with VA coverage, veterans without VA coverage, and adult non-veterans. We performed multivariable logistic regressions adjusted for demographics and self-reported health, with interaction terms to examine differential effects by race/ethnicity and income. KEY RESULTS Our sample included n=2,277 veterans with VA coverage, n=2,821 veterans without VA coverage, and n=46,456 non-veterans. Veterans were more often White and male; among veterans, those with VA coverage had worse health and lower incomes. Veterans with VA coverage had a higher unadjusted vaccination rate (63.0%) than veterans without VA coverage (59.1%) and non-veterans (46.5%) (p<0.05 for each comparison). In our adjusted model, non-veterans were 11.4 percentage points (95% CI -14.3, -8.5) less likely than veterans with VA coverage to be vaccinated, and veterans without VA coverage were 6.7 percentage points (95% CI -10.3, -3.0) less likely to be vaccinated than those with VA coverage. VA coverage, compared with non-veteran status, was also associated with reduced racial/ethnic and income disparities in vaccination. CONCLUSIONS VA coverage is associated with higher and more equitable influenza vaccination rates. A single-tier health system that emphasizes primary care may improve the uptake and equity of vaccination for influenza, and possibly other pathogens, like SARS-CoV2.
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Affiliation(s)
- Adam Gaffney
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - David U Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA.,Hunter College, City University of New York, New York, NY, USA.,Public Citizen Health Research Group, Washington, DC, USA
| | | | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Stephanie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA.,Hunter College, City University of New York, New York, NY, USA.,Public Citizen Health Research Group, Washington, DC, USA
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Qiao S, Li Z, Zhang J, Sun X, Garrett C, Li X. Social Capital, Urbanization Level, and COVID-19 Vaccination Uptake in the United States: A National Level Analysis. Vaccines (Basel) 2022; 10:vaccines10040625. [PMID: 35455373 PMCID: PMC9025929 DOI: 10.3390/vaccines10040625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination remains the most promising mitigation strategy for the COVID-19 pandemic. However, existing literature shows significant disparities in vaccination uptake in the United States. Using publicly available national-level data, we aimed to explore if county-level social capital can further explain disparities in vaccination uptake rates when adjusting for demographic and social determinants of health (SDOH) variables, and if association between social capital and vaccination uptake may vary by urbanization level. Bivariate analyses and a hierarchical multivariable quasi-binomial regression analysis were conducted, where the regression analysis was stratified by urban–rural status. The current study suggests that social capital contributes significantly to the disparities of vaccination uptake in the US. The results of the stratification analysis show common predictors of vaccine uptake but also suggest various patterns based on urbanization level regarding the associations of COVID-19 vaccination uptake with SDOH and social capital factors. The study provides a new perspective to address disparities in vaccination uptake through fostering social capital within communities; which may inform tailored public health intervention efforts to enhance social capital and promote vaccination uptake.
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Affiliation(s)
- Shan Qiao
- Department of Health Promotion, Education and Behavior, Smartstate Center of Healthcare Quality, Arnold School of Public Health, The University of South Carolina, Columbia, SC 29208, USA; (C.G.); (X.L.)
- Correspondence: ; Tel.: +1-(803)777-6844
| | - Zhenlong Li
- Department of Geography, The University of South Carolina, Columbia, SC 29208, USA;
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, SC 29208, USA; (J.Z.); (X.S.)
| | - Xiaowen Sun
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, The University of South Carolina, Columbia, SC 29208, USA; (J.Z.); (X.S.)
| | - Camryn Garrett
- Department of Health Promotion, Education and Behavior, Smartstate Center of Healthcare Quality, Arnold School of Public Health, The University of South Carolina, Columbia, SC 29208, USA; (C.G.); (X.L.)
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, Smartstate Center of Healthcare Quality, Arnold School of Public Health, The University of South Carolina, Columbia, SC 29208, USA; (C.G.); (X.L.)
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