Heterogeneity in Spatial Inequities in COVID-19 Vaccination Across 16 Large US Cities

Abstract

Differences in vaccination coverage can perpetuate coronavirus disease 2019 (COVID-19) disparities. We explored the association between neighborhood-level social vulnerability and COVID-19 vaccination coverage in 16 large US cities from the beginning of the vaccination campaign in December 2020 through September 2021. We calculated the proportion of fully vaccinated adults in 866 zip code tabulation areas (ZCTAs) of 16 large US cities: Long Beach, Los Angeles, Oakland, San Diego, San Francisco, and San Jose, all in California; Chicago, Illinois; Indianapolis, Indiana; Minneapolis, Minnesota; New York, New York; Philadelphia, Pennsylvania; and Austin, Dallas, Fort Worth, Houston, and San Antonio, all in Texas. We computed absolute and relative total and Social Vulnerability Index-related inequities by city. COVID-19 vaccination coverage was 0.75 times (95% confidence interval: 0.69, 0.81) or 16 percentage points (95% confidence interval: 12.1, 20.3) lower in neighborhoods with the highest social vulnerability as compared with those with the lowest. These inequities were heterogeneous, with cities in the West generally displaying narrower inequities in both the absolute and relative scales. The Social Vulnerability Index domains of socioeconomic status and of household composition and disability showed the strongest associations with vaccination coverage. Inequities in COVID-19 vaccinations hamper efforts to achieve health equity, as they mirror and could lead to even wider inequities in other COVID-19 outcomes.

Keywords: COVID-19; SARS-CoV-2; health disparities; health equity; neighborhoods; urban health; vaccination.

Figure 1

Scatterplots showing the relationship between the Social Vulnerability Index (SVI) and coronavirus disease 2019 vaccination coverage in neighborhoods of 16 US cities, through September 2021. Solid lines show locally weighted scatterplot smoothing (lowess) for each city separately. The SVI has been rescaled for each city to fit in a 0–1 range. Neighborhoods are proxied by zip code tabulation areas. A) Long Beach, CA; B) Los Angeles, CA; C) Oakland, CA; D) San Diego, CA; E) San Francisco, CA; F) San Jose, CA; G) Chicago, IL; H) Indianapolis, IN; I) Minneapolis, MN; J) New York City, NY; K) Philadelphia, PA; L) Austin, TX; M) Dallas, TX; N) Fort Worth, TX; O) Houston, TX; P) San Antonio, TX.

Figure 2

Coronavirus disease 2019 vaccination coverage by social vulnerability quintile (city-specific) and Census region in 16 large US cities, through September 2021. A) Midwest; B) Northeast; C) West; D) South.