COVID-19 Vaccine Rollouts and the Reproduction of Urban Spatial Inequality: Disparities Within Large US Cities in March and April 2021 by Racial/Ethnic and Socioeconomic Composition

Abstract

Rollouts of COVID-19 vaccines in the USA were opportunities to redress disparities that surfaced during the pandemic. Initial eligibility criteria, however, neglected geographic, racial/ethnic, and socioeconomic considerations. Marginalized populations may have faced barriers to then-scarce vaccines, reinforcing disparities. Inequalities may have subsided as eligibility expanded. Using spatial modeling, we investigate how strongly local vaccination levels were associated with socioeconomic and racial/ethnic composition as authorities first extended vaccine eligibility to all adults. We harmonize administrative, demographic, and geospatial data across postal codes in eight large US cities over 3 weeks in Spring 2021. We find that, although vaccines were free regardless of health insurance coverage, local vaccination levels in March and April were negatively associated with poverty, enrollment in means-tested public health insurance (e.g., Medicaid), and the uninsured population. By April, vaccination levels in Black and Hispanic communities were only beginning to reach those of Asian and White communities in March. Increases in vaccination were smaller in socioeconomically disadvantaged Black and Hispanic communities than in more affluent, Asian, and White communities. Our findings suggest vaccine rollouts contributed to cumulative disadvantage. Populations that were left most vulnerable to COVID-19 benefited least from early expansions in vaccine availability in large US cities.

Keywords: COVID-19; Disparities; Inequality; Neighborhood; Pandemic; Race; Socioeconomic; Spatial; Urban; Vaccine.

Fig. 1

COVID-19 vaccination levels in the population age 15 and older of ZIP Codes in eight large US cities, March and April 2021. Note: Figures are box-and-whisker plots of vaccination levels in $N=552$ ZIP Codes across eight of the 10 most populous US cities. The boxes represent interquartile ranges. The vertical lines represent medians. The horizontal lines extend from the 10th to the 90th percentiles. Circles represent observations below the 10th and above the 90th percentiles. The “% vaccinated” is the percent of the population age 15 and older with at least one dose of a COVID-19 vaccine

Fig. 2

Simulated COVID-19 vaccination levels by racial/ethnic and socioeconomic composition in the population age 15 and older of ZIP Codes across eight large US cities, March and April 2021. Note: This figure illustrates simulated sample-wide means assuming each ZIP Code had a given socioeconomic and racial/ethnic composition. We defined low and high levels as below the 10th and above the 90th within-city percentiles, respectively. We defined SES levels by setting all four socioeconomic variables to the same within-city percentiles within each scenario. We set other independent variables to within-city averages in each scenario. We include the true (observed) sample-wide average values of the dependent variable on the top row for comparison. The “% vaccinated” is the percent of the population age 15 and older with at least one dose of a COVID-19 vaccine