Social determinants of flu vaccine uptake among racial/ethnic minorities in the United States

Trust and Trustworthiness: Considerations for COVID-19 Vaccine Receipt in the Chicago Metropolitan Area

Black Americans are disproportionately affected by COVID-19 related disease and mortality due to longstanding social, political, economic, and environmental injustices. Although structural determinants of health have clear links to both COVID-19 disease and vaccine uptake, many public health researchers focus on the contribution of individual level trust in vaccine uptake, obscuring how distrust develops and is reinforced through continued systemic injustice. While much is known about relationship between individual trust and receipt of the COVID-19 vaccine, less is known about how structural racism and exposure to discrimination influence that association. Using survey data collected in the Chicago metropolitan area, we examined associations between structural racism, discrimination, and trust on two measures of vaccine acceptance: self-report receipt of any vaccine and completion of the primary series. Multiple variable logistic regression results suggest that participants who trusted the federal government to ensure a safe pediatric COVID-19 vaccine had higher odds of being vaccinated and completing the primary series. NH Black and Hispanic participants' distrust of their doctor to provide COVID-19 information reduced their odds of vaccine uptake. Trust in medical professionals was linked to higher odds of vaccine receipt for Hispanic participants but not for NH Black participants. Education consistently influenced the likelihood of receiving any vaccine for both NH Black and Hispanic participants, but not completing the primary series. Conversely, employment was strongly related to completing the primary series but not initial vaccine receipt. Measures of structural racism and discrimination had minimal impact on vaccine uptake in this sample.

Associations Between Demographic Factors, Clinical Variables, Social Determinants of Health, Vaccine Hesitancy, Vaccine Behavior, and Revaccination Status: A Survey of Adult HCT Survivors in the United States

Comprehensive survivorship care after hematopoietic cell transplantation (HCT) includes revaccination to restore immunity to vaccine-preventable diseases (VPDs). There is complexity to revaccination in this setting, and revaccination rates are sub-optimal. HCT survivors are at high-risk for morbidity and mortality from infections including VPDs, underscoring the importance of interventions to improve revaccination rates among survivors. Determining associations between survivor characteristics and revaccination uptake may guide interventions. The overall study objective was to advance our understanding of factors influencing revaccination uptake among adult HCT survivors living in the United States The specific study aims were to: (1) determine the prevalence of adult survivors who are completely, partially, or not revaccinated at 2 to 8 years after HCT and (2) examine associations between demographic variables, social determinants of health, clinical variables, past vaccination behaviors, vaccine hesitancy (Vaccination Confidence Scale), and revaccination status in adult HCT survivors. This study employed a one-time cross-sectional revaccination survey of adults who were surviving 2 to 8 years after HCT and living in the United States. The survey was sent to eligible survivors in the Fred Hutchinson Cancer Center Long-term Follow-up research cohort. The point prevalence of revaccination outcomes was determined from all the respondents (n = 338), differences in intent to revaccinate for people not yet fully revaccinated were explored using Fisher's exact test (n = 126), and associations were examined between revaccination outcomes and predictors using multivariable logistic regression (n = 292). Survey response rate was 30%. Among respondents, 62% were completely revaccinated, 33% were partially revaccinated, and 4% were not revaccinated. Most respondents (77%) who were not yet fully revaccinated planned to complete the revaccination protocol. However, fewer not-revaccinated respondents than partially revaccinated respondents planned to complete revaccination (50% versus 80%, P = .032). Factors associated with incomplete revaccination were shorter time from HCT, inadequate immune reconstitution, and not having received all childhood vaccines as a child. Our analysis has identified multiple variables associated with revaccination outcomes, indicating the potential for interventions to enhance post-HCT revaccination rates. Since many survivors cannot be revaccinated promptly due to delayed immune recovery, clinicians should iteratively re-evaluate for revaccination readiness as long as it takes to ensure eventual revaccination. Broader efforts by the healthcare community to increase childhood vaccine uptake might eventually support revaccination uptake. Future research that builds on these findings should focus on intervention testing.

Vaccine Equity: Lessons Learned Exploring Facilitators and Barriers to COVID-19 Vaccination in Urban Black Communities

COVID-19 vaccines were developed at unparalleled speed, but racial disparities persist in vaccine uptake. This is a cross-sectional survey that was conducted in mid-2021 in ambulatory clinics across Brooklyn, New York. The objectives of the study were to assess: knowledge of COVID-19, healthcare communication and access, attitudes including trust in the process of vaccine development and mistrust due to racial discrimination, and to determine the relationship of the above to vaccine receipt. 58 respondents self-identified as Black non-Hispanic and completed the survey: the majority were women (79%), <50 years old (65%), employed (66%), and had annual household income <$75,000 (59%). The majority reported having some health insurance (97%) and a regular place of healthcare (95%). 60% of respondents reported COVID-19 vaccination receipt. A significant percentage of the vaccinated group compared to the unvaccinated group scored higher on knowledge questions (91% vs. 65%; p = 0.018), felt it was important that others in the community get vaccinated (89% vs. 65%, p = 0.04), and trusted vaccine safety (86% vs. 35%; p < 0.0001) and effectiveness (88% vs. 48%; p < 0.001). The unvaccinated group reported a lower annual household income of <$75,000 (72% vs. 50%; p = 0.0002) and also differed by employment status (p = 0.04). Majority in both groups agreed that racial discrimination interferes with healthcare (78%). In summary, unvaccinated Black non-Hispanic respondents report significant concerns about vaccine safety and efficacy and have greater mistrust in the vaccine development process. The relationship between racial discrimination, mistrust, and vaccine hesitancy needs further study in order to improve vaccine uptake in this population.

Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria

BACKGROUND

There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria.

OBJECTIVES

This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis.

METHODS

This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study.

RESULTS

A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1-0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1-6-6.8).

CONCLUSION

Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.

Willingness to accept malaria vaccines amongst women presenting at outpatient and immunization clinics in Enugu state, Southeast Nigeria

Background

There are giant steps taken in the introduction of the novel malaria vaccine poised towards reducing mortality and morbidity associated with malaria.

Objectives

This study aimed to determine the knowledge of malaria vaccine and factors militating against willingness to accept the vaccine among mothers presenting in nine hospitals in Enugu metropolis.

Methods

This was a cross-sectional study carried out among 491 mothers who presented with their children in nine hospitals in Enugu metropolis, South-East Nigeria. A pre-tested and interviewer-administered questionnaire was used in this study.

Results

A majority of the respondents, 72.1% were aware of malaria vaccine. A majority of the respondents, 83.1% were willing to receive malaria vaccine. Similarly, a majority of the mothers, 92.9%, were willing to vaccinate baby with the malaria vaccine, while 81.1% were willing to vaccinate self and baby with the malaria vaccine. The subjects who belong to the low socio-economic class were five times less likely to vaccinate self and baby with malaria vaccine when compared with those who were in the high socio-economic class (AOR = 0.2, 95% CI 0.1–0.5). Mothers who had good knowledge of malaria vaccination were 3.3 times more likely to vaccinate self and baby with malaria vaccine when compared with those who had poor knowledge of malaria vaccination (AOR = 3.3, 95% CI 1–6–6.8).

Conclusion

Although the study documented a high vaccine acceptance among the mothers, there exists a poor knowledge of the malaria vaccine among them.

Survival Analysis and Socio-Cognitive Factors in the Timing of COVID-19 Vaccination Among Mexican-Origin Youth

OBJECTIVE

The COVID-19 pandemic disproportionately affected ethnic minority populations and exacerbated preexisting health disparities. The current study aims to promote vaccine uptake among Mexican-origin youth from immigrant families by examining their time to COVID-19 vaccine uptake and assessing the influence of demographic, cognitive, and social factors on the incidence of COVID-19 vaccination.

METHODS

The study conducted Survival Analysis using a Cox proportional hazards model based on a sample of 202 Mexican-origin youth (61.39% female; Mage = 20.41) with data collected from August 2021 to January 2023 in central Texas.

RESULTS

The results show a critical time period for vaccine uptake (i.e., in the first six months after the vaccines were publicly available), evidenced by a surge decrease in COVID-19 unvaccination probability. In addition, more positive attitudes toward the COVID-19 vaccine (Hazard ratio/HR = 1.89, 95% Confidence Interval/CI = [1.64, 2.18]), greater motivation (HR = 2.29, 95% CI = [1.85, 2.85]), higher education levels (HR = 1.52, 95% CI = [1.24, 1.86]), and fewer general barriers to COVID-19 vaccine knowledge (HR = 0.75, 95% CI = [0.60, 0.94]) were associated with greater incidences of receiving COVID-19 vaccines at any given time point during the pandemic.

CONCLUSION

The findings suggest that COVID-19 vaccine uptake among Mexican-origin youth occurred primarily within the initial months of vaccines being publicly distributed. To encourage vaccination among Mexican-origin youth, sustained COVID-19 vaccine promotion efforts are needed by targeting their motivation and positive attitudes and reducing barriers to vaccine information, particularly for youth with lower education levels.

Changes in Attitudes and Barriers to Seasonal Influenza Vaccination from 2007 to 2023

This study investigated how factors and barriers to flu vaccination among college students has changed over the past 16 years. Data were collected from 440 students using a survey and compared to previous data from the same university. Respondents were also asked about their experiences with Covid-19 and its effect on their intent to vaccinate. We found that vaccination rates had increased from 12.4 to 30.5%. Among the unvaccinated, expense, fear of getting influenza from vaccination, fear of side effects, and lack of information have decreased by 28%, 20%, 17%, and 15% respectively. Time, convenience, and perceived risk are still significant barriers to vaccination. Students are getting more encouragement to vaccinate from their health care providers and parents, but it is becoming less effective. The Covid-19 pandemic has changed vaccine attitudes and vaccine fatigue has been a large contributor. Additionally, political affiliation has become a predictor of flu vaccine uptake with conservatives being less likely to vaccinate. There has also been a shift in motivation from concern for personal safety to concern for public safety.

Influenza-Associated Outcomes and Healthcare Utilization by Race and Ethnicity in the USA: a Retrospective Cohort Study Using the National Inpatient Sample Database

BACKGROUND

The influenza virus continues to be a public health concern every season. We aimed to evaluate influenza-associated outcomes and healthcare utilization by race and ethnicity.

METHODS

We conducted a retrospective cohort study using the National Inpatient Sample across 2019 and 2020. Influenza pneumonia was selected as the principal diagnosis. Outcomes included mortality, use of respiratory support ventilation, length of stay, and total hospitalization charge. Regression models were adjusted for age, gender, Charlson Comorbidity Index, hospitals' region, bed size, teaching status, insurance status, and median income.

RESULTS

We identified 73,098 individuals hospitalized with influenza pneumonia; 39,807 and 33,291 were admitted in 2019 and 2020, respectively. The sample included 49,829 (68%) White, 11,356 (15.5%) Black, 7526 (10%) Hispanic, 1860 (2.5%) Asian/Pacific, and 617 (0.84%) Native American patients. In-hospital mortality rates and respiratory support (non-invasive ventilation and invasive mechanical ventilation) in 2019 and 2020 were not significantly different across all the races. In 2019 and 2020, the adjusted odds ratios of in-patient mortality were not significantly different. Asians had higher odds of receiving NIV in 2019 but not in 2020 compared to White patients (adjusted odds ratio (aOR) 1.67, p value 0.04). The adjusted odds ratios for receiving IMV were not significantly different between the races in 2019 and 2020.

CONCLUSIONS

This study contributes valuable insight into influenza-associated outcomes and healthcare utilization patterns among diverse racial and ethnic groups. Disparities in healthcare utilization were observed among younger (< 65 years) individuals of Black and Hispanic ethnicity.

Racial disparity in flu vaccine uptake among Asian American Individuals: A National Health Interview Survey Study

Vaccination coverage rates across Asian American subpopulations with atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus is not well-studied. We used data from the National Health Interview Survey (NHIS) from 2006-2018 and included participants with a history of ASCVD or diabetes. Vaccination coverage in White were compared with Chinese, Asian Indian, Filipino, and 'other Asian' (Japanese, Korean, and Vietnamese) adults using univariable and multivariable logistic regression models. We included 50,839 participants, mean age 62.7±0.1 years, 46.3% women, 89.1% US-born. Filipino (59%) and Asian Indian (56%) adults were less likely to receive influenza vaccine than 'other Asians' (66%), Chinese (65%), and White (60%) participants (P<0.001). In multivariable adjusted models, Chinese (OR=1.66, 1.02-2.69), Asian Indian (OR=1.50, 1.07-2.10), and 'other Asian' ethnicity (OR=1.81, 1.38-2.36) were associated with higher odds of receiving influenza vaccination compared with White. Influenza vaccine coverage remains suboptimal across all studied races/ethnicities.

COVID-19 Vaccine Hesitancy: The Role of Socioeconomic Factors and Spatial Effects

This paper investigates the spatial dimension of socioeconomic and demographic factors behind COVID-19 vaccine hesitancy. With a focus on a county with considerable sociodemographic diversity in the state of Texas, USA, we apply regression models to census-tract-level data of the unvaccinated population. In addition to disparities in accessing the vaccination service, particularly for residents in rural areas, empirical results confirm under-vaccination among lower socioeconomic neighborhoods and communities with signs of distrust in government. The spatial model regressions further underscore the impact that vaccine hesitancy among residents in one community spread to its nearby communities. This observed spatial spillover effect is attributable to the geographic interactions of similar socioeconomic groups.