County Social Vulnerability and Influenza Vaccine Rates: National and Local Estimates for Medicare Recipients

Social Vulnerability Index and Health Outcomes in the United States: A Systematic Review

The Centers for Disease Control and Prevention created the Social Vulnerability Index (SVI) for the purpose of allocating resources in times of emergency based on social determinants of health (SDOH). The purpose of this systematic review was to evaluate how the SVI tool has been applied in health care literature focused on health in the United States (US). A systematic literature review was conducted in 7 research databases with an 11-year time frame reflecting the launch of SVI, with the last search completed on September 29, 2022. Studies were included that involved humans, health, SVI, and conducted in the US. Articles were excluded if the SVI was used in COVID-19, disaster, pandemic, environment, or hazards. A total of 47 articles were included in the systematic review. The majority of studies analyzed individual/population health outcomes in clinical, surgical, mortality, or health promotion areas. The majority of studies showed a relationship between neighborhood-level SDOH and health outcomes. Study authors reported strengths, limitations, and recommendations of the SVI tool. A potential limitation of the study was the exclusion of studies that used the SVI related to disaster. The SVI represents a powerful tool to assess neighborhood-level SDOH and examine upstream drivers health outcomes with direct implications for research, policy, and practice.

Interventions to Improve COVID-19 Vaccine Hesitancy

Coronavirus disease 2019 (COVID-19) vaccine uptake among individuals with rheumatic conditions remains low despite heightened risk for related adverse outcomes. This is especially pronounced among historically marginalized populations who suffered disproportionately from the COVID-19 pandemic. Among the myriad of reasons for low vaccine uptake, mistrust in the healthcare system, misinformation related to the vaccine development process, fear of rheumatic disease flares, and inconsistent physician recommendations, are highlighted. Two randomized controlled trials are underway leveraging multimodal strategies and community partnerships to disseminate COVID-19 vaccine information, reduce hesitancy and hopefully improve vaccine uptake, particularly in marginalized communities.

Disparities in Vaccination Amongst Socially Vulnerable Patients with Inflammatory Bowel Disease

INTRODUCTION

Social determinants of health (SDOH) have a known impact on disparities in vaccination. Despite an increased risk for infection in patients with inflammatory bowel disease (IBD), SDOH and vaccination in this population have not been studied. Using census tract-level data from the Centers for Disease Control's social vulnerability index (SVI), we aimed to understand the relationship between SDOH and adherence to guideline-recommended vaccinations in patients with IBD.

METHODS

A single-center retrospective cohort of patients with IBD was used to geocode patient addresses to their individual census tract and corresponding SVI and subthemes (Socioeconomic Status, Household Composition, Minority Status, and Housing/Transportation). We used separate multivariable logistic regressions to examine the relationship between SVI and vaccination against influenza, COVID-19, pneumococcal pneumonia, and herpes zoster.

RESULTS

A total of 7,036 patients were included. Rates of vaccination varied across vaccine-types: influenza (57%), COVID-19 (65%), pneumococcal pneumonia (58%), and herpes zoster (11%). High social vulnerability was associated with lower odds of vaccination against influenza (OR 0.47, p < 0.001), COVID-19 (OR 0.54, p < 0.001), pneumonia (OR 0.73, p = 0.012), and herpes zoster (OR 0.39, p < 0.001). Within the SVI subthemes, Socioeconomic Status, Household Composition, and Minority Status were important factors associated with differences in vaccine uptake.

CONCLUSION

Higher social vulnerability was associated with lower rates of vaccination across all vaccine types. Identifying these disparities in vaccination for socially vulnerable patients with IBD is the first step to reducing preventable infections and ensuring all patients receive high quality, equitable care.

Individual and community socioeconomic status and receipt of influenza vaccines among adult primary care patients in a large academic health system: 2017-2019

Introduction

Influenza causes significant mortality and morbidity in the U.S., yet less than half of adults receive influenza vaccination. We use census-tract level social vulnerability index (SVI) to examine community- and individual-level characteristics of influenza vaccine coverage among primary care patients at an academic health system in Los Angeles, CA.

Methods

We used electronic medical records (EMR) data of 247,773 primary care patients for 2017-18 and 2018-19 influenza seasons. We geocoded patients' addresses to identify their SVI and merged them with EMR data. We specified mixed-effects logistic regression models estimating the association between patient's vaccine receipt and SVI, adjusting for sociodemographics, Charlson Comorbidity Index, and health insurance.

Results

Vaccination coverage was higher during the 2018-19 influenza season (34%) compared to the 2017-18 season (23%). In adjusted analyses, higher SVI, lower individual socioeconomic status and racial and ethnic minority status were independently associated with lower odds of vaccination. Patients on Medicaid had lower odds of vaccine receipt (adjusted Odds Ratio [aOR] = 0.77 for <65, aOR = 0.30 for 65+) than patients on commercial health insurance. Asian Non-Hispanic patients had higher odds than White Non-Hispanic patients (aOR = 2.39 for <65, aOR = 1.91 for 65+), while Black Non-Hispanic patients had lower odds (aOR = 0.49 for <65, aOR = 0.59 for 65+).

Conclusions

Community and individual socioeconomic status and race and ethnicity were associated with influenza vaccination. Health systems can use SVI to identify communities at increased risk of influenza mortality and morbidity, and engage with community partners to develop communication strategies and invest in interventions to increase vaccine accessibility in under-resourced neighborhoods.

Social Vulnerability, Intervention Utilization, and Outcomes in US Adults Hospitalized With Influenza

Importance

Seasonal influenza is associated with substantial disease burden. The relationship between census tract-based social vulnerability and clinical outcomes among patients with influenza remains unknown.

Objective

To characterize associations between social vulnerability and outcomes among patients hospitalized with influenza and to evaluate seasonal influenza vaccine and influenza antiviral utilization patterns across levels of social vulnerability.

Design, Setting, and Participants

This retrospective repeated cross-sectional study was conducted among adults with laboratory-confirmed influenza-associated hospitalizations from the 2014 to 2015 through the 2018 to 2019 influenza seasons. Data were from a population-based surveillance network of counties within 13 states. Data analysis was conducted in December 2023.

Exposure

Census tract-based social vulnerability.

Main Outcomes and Measures

Associations between census tract-based social vulnerability and influenza outcomes (intensive care unit admission, invasive mechanical ventilation and/or extracorporeal membrane oxygenation support, and 30-day mortality) were estimated using modified Poisson regression as adjusted prevalence ratios. Seasonal influenza vaccine and influenza antiviral utilization were also characterized across levels of social vulnerability.

Results

Among 57 964 sampled cases, the median (IQR) age was 71 (58-82) years; 55.5% (95% CI, 51.5%-56.0%) were female; 5.2% (5.0%-5.4%) were Asian or Pacific Islander, 18.3% (95% CI, 18.0%-18.6%) were Black or African American, and 64.6% (95% CI, 64.2%-65.0%) were White; and 6.6% (95% CI, 6.4%-68%) were Hispanic or Latino and 74.7% (95% CI, 74.3%-75.0%) were non-Hispanic or Latino. High social vulnerability was associated with higher prevalence of invasive mechanical ventilation and/or extracorporeal membrane oxygenation support (931 of 13 563 unweighted cases; adjusted prevalence ratio [aPR], 1.25 [95% CI, 1.13-1.39]), primarily due to socioeconomic status (790 of 11 255; aPR, 1.31 [95% CI, 1.17-1.47]) and household composition and disability (773 of 11 256; aPR, 1.20 [95% CI, 1.09-1.32]). Vaccination status, presence of underlying medical conditions, and respiratory symptoms partially mediated all significant associations. As social vulnerability increased, the proportion of patients receiving seasonal influenza vaccination declined (-19.4% relative change across quartiles; P < .001) as did the proportion vaccinated by October 31 (-6.8%; P < .001). No differences based on social vulnerability were found in in-hospital antiviral receipt, but early in-hospital antiviral initiation (-1.0%; P = .01) and prehospital antiviral receipt (-17.3%; P < .001) declined as social vulnerability increased.

Conclusions and Relevance

In this cross-sectional study, social vulnerability was associated with a modestly increased prevalence of invasive mechanical ventilation and/or extracorporeal membrane oxygenation support among patients hospitalized with influenza. Contributing factors may have included worsened baseline respiratory health and reduced receipt of influenza prevention and prehospital or early in-hospital treatment interventions among persons residing in low socioeconomic areas.

A health equity science approach to assessing drivers of COVID-19 vaccination coverage disparities over the course of the COVID-19 pandemic, United States, December 2020-December 2022

INTRODUCTION

Health equity science examines underlying social determinants, or drivers, of health inequities by building an evidence base to guide action across programs, public health surveillance, policy, and communications efforts. A Social Vulnerability Index (SVI) was utilized during the COVID-19 response to identify areas where inequities exist and support communities with vaccination. We set out to assess COVID-19 vaccination coverage by two SVI themes, Racial and Ethnicity Minority Status and Housing Type and Transportation to examine disparities.

METHODS

US county-level COVID-19 vaccine administration data among persons aged 5 years and older reported to the Centers for Disease Control and Prevention from December 14, 2020 to December 14, 2022, were analyzed. Counties were categorized 1) into tertiles (low, moderate, high) according to each SVI theme's level of vulnerability or 2) dichotomized by urban or rural classification. Primary series vaccination coverage per age group were assessed for SVI social factors by SVI theme tertiles or urbanicity.

RESULTS

Older adults aged 65 years and older had the highest vaccination coverage across all vulnerability factors compared with children aged 5-17 years and adults aged 18-64 years. Overall, children and adults had higher vaccination coverage in counties of high vulnerability. Greater vaccination coverage differences were observed by urbanicity as rural counties had some of the lowest vaccination coverage for children and adults.

CONCLUSION

COVID-19 vaccination efforts narrowed gaps in coverage for adults aged 65 years and older but larger vaccination coverage differences remained among younger populations. Moreover, greater disparities in coverage existed in rural counties. Health equity science approaches to analyses should extend beyond identifying differences by basic demographics such as race and ethnicity and include factors that provide context (housing, transportation, age, and geography) to assist with prioritization of vaccination efforts where true disparities in vaccination coverage exist.

Exploring the role of the social vulnerability index in understanding COVID-19 immunization rates

Communities that are historically marginalized and minoritized were disproportionately impacted by the COVID-19 pandemic due to long-standing social inequities. It was found that those who experience social vulnerabilities faced a heightened burden of COVID-19 morbidities and mortalities and concerningly lower rates of COVID-19 vaccination. The CDC's Social Vulnerability Index (CDC-SVI) is a pivotal tool for planning responses to health crises such as the COVID-19 pandemic. This study explores the associations between CDC-SVI and its corresponding themes with COVID-19 vaccine uptake in Nevada counties. Additionally, the study discusses the utility of the CDC-SVI in the context of equitable vaccine uptake in a pandemic setting. We examined the linear association between the 2020 CDC-SVI (including the composite score and the four themes) and COVID-19 vaccine uptake (including initial and complete vaccinations) for the seventeen Nevada counties. These associations were further examined for spatial-varied effects. Each CDC-SVI theme was negatively correlated with initial and complete COVID-19 vaccine uptake (crude) except for minority status, which was positively correlated. However, all correlations were found to be weak. Excessive vaccination rates among some counties are not explained by the CDC-SVI. Overall, these findings suggest the CDC-SVI themes are a better predictor of COVID-19 vaccine uptake than the composite SVI score at the county level. Our findings are consistent with similar studies. The CDC-SVI is a useful measure for public health preparedness, but with limitations. Further understanding is needed of which measures of social vulnerability impact health outcomes.

Regional factors associated with pneumococcal vaccination coverage among U.S. adults with underlying chronic or immunocompromising conditions

The Centers for Disease Control recommends pneumococcal vaccination for U.S. adults aged 19-64 years with chronic or immunocompromising conditions, however, vaccination coverage is low and regional variations in coverage are rarely studied. This study examined pneumococcal vaccination coverage at the metropolitan statistical area (MSAs) level and identified regional factors associated with pneumococcal vaccination using the combined IBM® Watson Health MarketScan® Commercial and Medicare Supplemental databases. Pneumococcal vaccination coverage, clinical and socioeconomic factors were calculated for each MSA. Ordinary least square and spatial regression models were used to examine factors associated with vaccination. Results indicated that the national pneumococcal vaccination coverage was 13.4% with a large variation across MSAs (0-34%). The spatial error model, model with the best fit, showed that proportions of the population who were ≥50 years of age, received an influenza vaccine, or had health maintenance organization health plans were positively associated with pneumococcal vaccination coverage. In summary, we found that national pneumococcal vaccination coverage was low and there was substantial variation across MSAs. Regional factors identified may help inform interventions to improve pneumococcal vaccination coverage across geographies.

Geographically varying associations between mentally unhealthy days and social vulnerability in the USA

OBJECTIVES

A growing body of research has incorporated the Social Vulnerability Index (SVI) into an expanded understanding of the social determinants of health. Although each component of SVI and its association with individual-level mental health conditions have been well discussed, variation in mentally unhealthy days (MUDs) at a county level is still unexplored. To systematically examine the geographically varying relationships between SVI and MUDs across the US counties, our study adopted two different methods: 1) aspatial regression modeling (ordinary least square [OLS]); and 2) locally calibrated spatial regression (geographically weighted regression [GWR]).

STUDY DESIGN

This study used a cross-sectional statistical design and geospatial data manipulation/analysis techniques. Analytical unit is each of the 3109 counties in the continental USA.

METHODS

We tested the model performance of two different methods and suggest using both methods to reduce potential issues (e.g., Simpson's paradox) when researchers apply aspatial analysis to spatially coded data sets. We applied GWR after checking the spatial dependence of residuals and non-stationary issues in OLS. GWR split a single OLS equation into 3109 equations for each county.

RESULTS

Among 15 SVI variables, a combination of eight variables showed the best model performance. Notably, unemployment, person with a disability, and single-parent households with children aged under 18 years especially impacted the variation of MUDs in OLS. GWR showed better model performance than OLS and specified each county's varying relationships between subcomponents of SVI and MUDs. For example, GWR specified that 69.3% (2157 of 3109) of counties showed positive relationships between single-parent households and MUDs across the USA. Higher positive relationships were concentrated in Michigan, Kansas, Texas, and Louisiana.

CONCLUSIONS

Our findings could contribute to the literature regarding social determinants of community mental health by specifying spatially varying relationships between SVI and MUDs across US counties. Regarding policy implementation, in counties containing more social and physical minorities (e.g., single-parent households and disabled population), policymakers should attend to these groups of people and increase intervention programs to reduce potential or current mental health illness. The results of GWR could help policymakers determine the specific counties that need more support to reduce regional mental health disparities.

Investigation of barriers to county-level seasonal influenza vaccine uptake among Medicare beneficiaries in the United States - 2018-2019 seasonal influenza season

Introduction

As most public health decisions are made at the local level, public health interventions implemented at the local level may vary by their own unique circumstances, such as demographic composition or the availability of resources. Our objective is to estimate and characterize county-level flu vaccine uptakes among Medicare-covered adults aged ≥65 years.

Methods

The flu vaccine uptake was estimated from Medicare Fee-for-Service claims for those who continuously enrolled during the 2018-2019 flu season. County-level characteristics were obtained from Centers for Disease Control and Prevention (CDC)'s Minority Health Social Vulnerability Index and Behavioral Risk Factor Surveillance System data as well as Health Resources and Services Administration's Area Health Resources File. A generalized linear regression was used to assess the relationship between selected characteristics and uptake.

Results

A total of 30,265,047 beneficiaries from 3,125 counties were identified, of which 53% received a flu vaccination during the 2018-2019 flu season. For 3,006 counties with more than 500 Medicare beneficiaries, the mean county-level uptake was estimated to be 47.7%. The mean uptakes in counties designated as a health professional shortage area (HPSA) (42.6% and 48.4%, respectively), were lower than the uptakes for the non-HPSA counties (53.8%). Metro counties (53.2%) showed higher uptakes than non-metro counties (44.2%). Regression analysis results showed that the percent of working adults aged 18-64 years and female were positively associated, while the percent of Black and Hispanic adults were negatively associated. Proportions of persons with limited proficiency of English, college education or above, single parent families, multi-unit housing, and living in group quarters were positively associated and significant.

Conclusions

The results confirmed that county-level flu vaccine uptakes are low, reflect persistent racial disparities in vaccine uptake, and that Medicare populations in medically underserved communities with lower socioeconomic status need more attention in improving flu vaccine uptake.

Association of dual COVID-19 and seasonal influenza vaccination with COVID-19 infection and disease severity

The clinical guideline states that COVID-19 vaccination can be administered concurrently with Influenza (flu) vaccination (dual vaccination). Using data from the 2021 National Health Interview Survey, we conducted descriptive analysis and multivariate logistic regressions to examine the association between dual vaccination status and self-reported COVID-19 infection and severity. Among 21,387 (weighted 185,251,310) U.S. adults, about 22% did not receive either the flu or COVID-19 vaccine, 6.0% received the flu vaccine only, 29.1% received the COVID-19 vaccine only, and 42.5% received both vaccines. In the multivariate analysis, individuals with dual vaccination (OR, 0.65, 95% CI, 0.56-0.75) and COVID-19 vaccine only (OR, 0.71, 95% CI, 0.61-0.82) were significantly less likely to report COVID-19 infection when compared with those unvaccinated. There was no significant difference in self-reported COVID-19 symptom severity by vaccination status. The results suggest that dual vaccination may be an effective strategy to reduce the contagious respiratory disease burden.

Public attitudes about equitable COVID-19 vaccine allocation: a randomised experiment of race-based versus novel place-based frames

Equity was-and is-central in the US policy response to COVID-19, given its disproportionate impact on disadvantaged communities of colour. In an unprecedented turn, the majority of US states used place-based disadvantage indices to promote equity in vaccine allocation (eg, through larger vaccine shares for more disadvantaged areas and people of colour).We conducted a nationally representative survey experiment (n=2003) in April 2021 (before all US residents had become vaccine eligible), that examined respondents' perceptions of the acceptability of disadvantage indices relative to two ways of prioritising racial and ethnic groups more directly, and assessed the role of framing and expert anchors in shaping perceptions.A majority of respondents supported the use of disadvantage indices, and one-fifth opposed any of the three equity-promoting plans. Differences in support and opposition were identified by respondents' political party affiliation. Providing a numerical anchor (that indicated expert recommendations and states' actual practices in reserving a proportion of allocations for prioritised groups) led respondents to prefer a lower distribution of reserved vaccine allocations compared with the randomised condition without this anchor, and the effect of the anchor differed across the frames.Our findings support ongoing uses of disadvantage indices in vaccine allocation, and, by extension, in allocating tests, masks or treatments, especially when supply cannot meet demand. The findings can also inform US allocation frameworks in future pandemic planning, and could provide lessons on how to promote equity in clinical and public health outside of the pandemic setting.

Association between social vulnerability and COVID-19 vaccination hesitancy and vaccination in pregnant and postpartum individuals

OBJECTIVE

To evaluate the association of community-level social vulnerability with COVID-19 vaccine hesitancy and vaccination among pregnant and postpartum individuals.

METHODS

Prospective cohort study assessing COVID-19 vaccine hesitancy among pregnant and postpartum individuals. We performed a baseline survey on COVID-19 vaccine hesitancy from 03/22/21 to 04/02/21, and a follow-up survey on COVD-19 vaccination status 3- to 6-months later. The primary exposure was the Centers for Disease Control and Prevention SVI (Social Vulnerability Index), measured in quartiles. Higher SVI quartiles indicated greater community-level social vulnerability with the lowest quartile (quartile 1) as the referent group. The primary outcome was COVID-19 vaccine hesitancy on the baseline survey (uncertainty or refusal of the vaccine), and the secondary outcome was self-report of not being vaccinated (unvaccinated) for COVID-19 on the follow-up survey.

RESULTS

Of 456 assessed individuals, 46% reported COVID-19 vaccine hesitancy on the baseline survey; and of 290 individuals (290/456, 64%) who completed the follow-up survey, 48% (140/290) were unvaccinated. The frequency of baseline vaccine hesitancy ranged from 25% in quartile 1 (low SVI) to 68% in quartile 4 (high SVI), and being unvaccinated at follow-up ranged from 29% in quartile 1 to 77% in quartile 4. As social vulnerability increased, the risk of COVID-19 vaccine hesitancy at baseline increased (quartile 2 aRR (adjusted relative risk): 1.46; 95% CI:0.98 to 2.19; quartile 3 aRR: 1.86; 95% CI:1.28 to 2.71; and quartile 4 aRR: 2.24; 95% CI:1.56 to 3.21), as did the risk of being unvaccinated at follow-up (quartile 2 aRR: 1.00; 95% CI:0.66 to 1.51; quartile 3 aRR: 1.68; 95% CI:1.17 to 2.41; and quartile 4 aRR: 1.82; 95% CI:1.30 to 2.56).

CONCLUSIONS

Pregnant and postpartum individuals living in an area with higher community-level social vulnerability were more likely to report COVID-19 vaccine hesitancy and subsequently to be unvaccinated at follow-up.

Skeptical Health Mavens May Limit COVID-19 Vaccine Diffusion: Using the Innovation Diffusion Cycle to Interpret Results of a Cross-sectional Survey among People Who are Socially Vulnerable

We sought to identify barriers to COVID-19 vaccine uptake among persons who are socially vulnerable in light of the natural cycle of innovation diffusion. Widespread adoption of a health innovation requires a cadre of opinion leaders to build on successes experienced by early adopters. One type of opinion leader in healthcare are health mavens: members of a community who maintain up-to-date health knowledge and share their knowledge others. We surveyed 139 persons who are socially vulnerable regarding their COVID-19 vaccination intention, and evaluated their responses based on psychological traits captured by two scales: innovativeness and health mavenism. Health mavenism was not strongly correlated with COVID-19 vaccine intention. Health mavens often relied on their own healthcare providers (n = 46) and health agency websites (n = 42) for vaccine information. Those who relied on their faith leaders (n = 4) reported a lower likelihood of getting vaccinated (31.5% vs. 76.0%, p < .05). The observed lack of support by health mavens represents a critical barrier to COVID-19 vaccine uptake; targeting campaigns to health mavens may increase COVID-19 vaccine uptake in socially vulnerable communities.

Association between social vulnerability and influenza and tetanus-diphtheria-acellular pertussis vaccination in pregnant and postpartum individuals

BACKGROUND

Despite current guidelines recommending universal vaccination, the frequency of vaccination in pregnancy for influenza and tetanus-diphtheria-acellular pertussis remains low.

OBJECTIVE

This study aimed to evaluate the association between community-level social vulnerability and influenza and anticipated tetanus-diphtheria-acellular pertussis vaccinations among pregnant and postpartum individuals.

STUDY DESIGN

We conducted a cross-sectional survey of vaccine hesitancy in the peripartum period among pregnant and postpartum participants enrolled in prenatal care at a single tertiary care center from March 22, 2021, to April 02, 2021. Participant addresses were geocoded using ArcGIS and linked at the census tract level. The primary exposure was community-level social vulnerability as measured by the US Centers for Disease Control and Prevention's Social Vulnerability Index. This index incorporates 15 census variables to produce a composite score and subscores across 4 major thematic domains (socioeconomic status, household composition and disability, minority status and language, and housing type and transportation). The scores range from 0 to 1, with higher values indicating greater social vulnerability. The primary outcomes were self-reported influenza vaccination during the current influenza season and having received or planning to receive the tetanus-diphtheria-acellular pertussis vaccination in pregnancy. We used multivariable logistic regression and adjusted for age, self-reported race and ethnicity, parity, trimester of pregnancy, and chronic comorbid conditions.

RESULTS

Of 456 assessed individuals (95% pregnant individuals and 5% postpartum individuals), the frequency of influenza vaccination was 58% (95% confidence interval, 53-62), and the anticipated tetanus-diphtheria-acellular pertussis vaccination was 72% (95% confidence interval, 68-76). Individuals from communities with a higher Social Vulnerability Index were less likely to report vaccination in pregnancy than those from communities with a lower Social Vulnerability Index. Specifically, for each 0.1-unit increase in the Social Vulnerability Index, the odds of influenza vaccination (adjusted odds ratio, 0.23; 95% confidence interval, 0.11-0.46) and anticipated tetanus-diphtheria-acellular pertussis vaccination (adjusted odds ratio, 0.24; 95% confidence interval, 0.11-0.53) decreased by >70%. By domain, the Social Vulnerability Index subscores of socioeconomic status (influenza adjusted odds ratio, 0.20 [95% confidence interval, 0.10-0.40]; tetanus-diphtheria-acellular pertussis adjusted odds ratio, 0.25 [95% confidence interval, 0.12-0.53]) and housing type and transportation (influenza adjusted odds ratio, 0.41 [95% confidence interval, 0.19-0.84; tetanus-diphtheria-acellular pertussis adjusted odds ratio, 0.39 [95% confidence interval, 0.18-0.87) were inversely associated with a lower odds of influenza and tetanus-diphtheria-acellular pertussis vaccinations.

CONCLUSION

Pregnant and postpartum individuals living in areas with higher social vulnerability were less likely to report influenza and anticipated tetanus-diphtheria-acellular pertussis vaccinations in pregnancy. The Social Vulnerability Index could be used as a tool to improve vaccine equity and address disparities in vaccination in pregnancy.