Factors associated with early receipt of COVID-19 vaccination and adherence to second dose in the Veterans Affairs healthcare system

Abstract

Background: We aimed to determine factors independently associated with early COVID-19 vaccination and adherence to two-dose regimens.

Methods: Among persons receiving care in the Veterans Affairs (VA) healthcare system (n = 5,766,638), we identified those who received at least one dose of COVID-19 vaccination through the VA, during the first ~3months following emergency use authorization, from December 11, 2020 to March 9, 2021 (n = 1,569,099, or 27.2%, including 880,200 (56.1%) Moderna, 676,279 (43.1%) Pfizer-BioNTech and 12,620 (0.8%) Janssen vaccines).

Results: Follow-up for receipt of vaccination began on December 11, 2020. After adjustment for baseline characteristics ascertained as of December 11, 2020, factors significantly associated with vaccination included older age, higher comorbidity burden, higher body mass index category, Black (vs. White) race (adjusted hazard ratio [AHR] 1.19, 95% CI 1.19-1.20), Hispanic (vs. non-Hispanic) ethnicity (AHR 1.12, 95% CI 1.11-1.13), urban (vs. rural) residence (AHR 1.31, 95% CI 1.31-1.31), and geographical region, while AI/AN race (vs. White), was associated with lower vaccination rate (AHR 0.85, 95% CI 0.84-0.87). Among persons who received both doses of Moderna or Pfizer-BioNTech vaccines, 95.3% received the second dose within ±4 days of the recommended date. Among persons who received the first vaccine dose, only 3.2% did not receive the second dose within 42 days for Pfizer versus 4.0% for Moderna (p<0.001). Factors independently associated with higher likelihood of missing the second dose included younger age (10.83% in 18-50 yo vs. 2.72% in 70-75 yo), AI/AN race, female sex, rural location, geographical region and prior positive test for SARS-CoV-2.

Conclusions: We identified sociodemographic and clinical factors that may be used to target vaccination efforts and to further improve adherence to second vaccine dosing.

Fig 1. Cumulative incidence of receiving vaccination by age category (a) or CCI category (b) and timing of second vaccination dose (c).

a. Kaplan-Meier cumulative incidence of vaccination from December 11, 2020 to March 9, 2021 by age group. b. Kaplan-Meier cumulative incidence of vaccination from December 11, 2020 to March 9, 2021 by Charlson Comorbidity Index (CCI) group. c. Distribution of the timing of the second doses of Pfizer-BioNTech and Moderna vaccines, shown as days from the recommended date (which is 21 days from the first dose for Pfizer-BioNTech and 28 days for Moderna).