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. 2023 May 3;76(9):1615-1625.
doi: 10.1093/cid/ciad003.

Relationships Between Social Vulnerability and Coronavirus Disease 2019 Vaccination Coverage and Vaccine Effectiveness

Alexandra F Dalton  1 , Zachary A Weber  2 , Katie S Allen  3   4 , Edward Stenehjem  5 , Stephanie A Irving  6 , Talia L Spark  2 , Katherine Adams  1 , Ousseny Zerbo  7 , Victoria Lazariu  2 , Brian E Dixon  3   4 , Kristin Dascomb  5 , Emily Hartmann  8 , Anupam B Kharbanda  9 , Toan C Ong  10 , Malini B DeSilva  11 , Maura Beaton  12 , Manjusha Gaglani  13   14 , Palak Patel  1 , Allison L Naleway  6 , Magdalene N S Kish  2 , Shaun J Grannis  3   4 , Nancy Grisel  5 , Chantel Sloan-Aagard  8   15 , Suchitra Rao  10 , Chandni Raiyani  13 , Monica Dickerson  1 , Elizabeth Bassett  2 , William F Fadel  3   4 , Julie Arndorfer  5 , Juan Nanez  8 , Michelle A Barron  10 , Gabriela Vazquez-Benitez  11 , I Chia Liao  13 , Eric P Griggs  1 , Sarah E Reese  2 , Nimish R Valvi  3 , Kempapura Murthy  13 , Elizabeth A K Rowley  2 , Peter J Embi  3   16 , Sarah Ball  2 , Ruth Link-Gelles  1 , Mark W Tenforde  1
Affiliations

Relationships Between Social Vulnerability and Coronavirus Disease 2019 Vaccination Coverage and Vaccine Effectiveness

Alexandra F Dalton et al. Clin Infect Dis. .

Abstract

Background: Coronavirus disease 2019 (COVID-19) vaccination coverage remains lower in communities with higher social vulnerability. Factors such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure risk and access to healthcare are often correlated with social vulnerability and may therefore contribute to a relationship between vulnerability and observed vaccine effectiveness (VE). Understanding whether these factors impact VE could contribute to our understanding of real-world VE.

Methods: We used electronic health record data from 7 health systems to assess vaccination coverage among patients with medically attended COVID-19-like illness. We then used a test-negative design to assess VE for 2- and 3-dose messenger RNA (mRNA) adult (≥18 years) vaccine recipients across Social Vulnerability Index (SVI) quartiles. SVI rankings were determined by geocoding patient addresses to census tracts; rankings were grouped into quartiles for analysis.

Results: In July 2021, primary series vaccination coverage was higher in the least vulnerable quartile than in the most vulnerable quartile (56% vs 36%, respectively). In February 2022, booster dose coverage among persons who had completed a primary series was higher in the least vulnerable quartile than in the most vulnerable quartile (43% vs 30%). VE among 2-dose and 3-dose recipients during the Delta and Omicron BA.1 periods of predominance was similar across SVI quartiles.

Conclusions: COVID-19 vaccination coverage varied substantially by SVI. Differences in VE estimates by SVI were minimal across groups after adjusting for baseline patient factors. However, lower vaccination coverage among more socially vulnerable groups means that the burden of illness is still disproportionately borne by the most socially vulnerable populations.

Keywords: COVID-19; Social Vulnerability Index; vaccination coverage; vaccine effectiveness.

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Conflict of interest statement

Potential conflicts of interest. B. E. D. reported consulting fees for advisory panel on HPV vaccination from Merck & Co and book royalties from Elsevier (book on HIE) as well as Springer Nature (book on Public Health Informatics), and grant to evaluate HIE technologies from US National Institutes of Health (NIH), grant to use HIE data for public health surveillance from CDC, R21 grant to evaluate HIE technologies from US Agency for Healthcare Research and Quality, grant to evaluate HIE technologies from US Department of Veterans Affairs. G. V. B. reported grants or contracts from Sanofi for Tdap Vaccine Safety and from CDC for Vaccine Safety Datalink. A. I. N. received institutional support from Pfizer for an unrelated study of meningococcal B vaccine safety during pregnancy and institutional research funding from Vir Biotechnology for unrelated influenza study. S. Rao received grant funding from GlaxoSmithKline. S. A. I. reports contract no. 200-2012-53584 (Vaccine Safety Datalink) from CDC. M. B. reports Columbia University is part of the VISION surveillance network and receives funding from Westat to support work done at Columbia as part of VISION. M. G. reports Ambulatory US Flu/COVID VE Network institutional grant, HAIVEN Adult Inpatient Flu/COVID VE institutional grant from CDC, IVY-3 PHS project institutional subcontract from CDC-Vanderbilt, and RECOVER study institutional subcontract from CDC-Abt. K. M. reports contracts or grants paid to institution from US CDC Ambulatory US Flu VE Network and US CDC HAIVEN—Hospitalized Adult Influenza Vaccine Effectiveness Network. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Date COVID-19 primary series vaccination (2 mRNA doses or 1 Johnson & Johnson/Janssen [J&J] dose) completed by SVI quartile among unique subjects, 1 January 2021–8 July 2022*. *In the states represented in this analysis, the Delta variant was predominant from 1 June–3 July 2021, through 15 December–28 December 2021, depending on site. The Omicron variant was predominant beginning December 16–29 2021, through the conclusion of the study period. Abbreviations: COVID-19, coronavirus disease 2019; mRNA, messenger RNA; SVI, Social Vulnerability Index.
Figure 2.
Figure 2.
Date COVID-19 booster dose completed by SVI quartile among unique subjects with a completed primary series (3 mRNA doses or 1 Johnson & Johnson/Janssen [J&J] dose plus additional vaccine dose), 1 September 2021 to 8 July 2022*. *In the states represented in this analysis, the Delta variant was predominant from 1 June–3 July 2021, through 15 December–28 December 2021, depending on site. The Omicron variant was predominant beginning December 16–29 2021, through the conclusion of the study period. Abbreviations: COVID-19, coronavirus disease 2019; mRNA, messenger RNA; SVI, Social Vulnerability Index.
Figure 3.
Figure 3.
mRNA COVID-19 vaccine effectiveness against laboratory-confirmed COVID-19-associated emergency department or urgent care event by SVI quartile, vaccine doses and timing, and SARS-CoV-2 subvariant era. Abbreviations: COVID-19, coronavirus disease 2019; mRNA, messenger RNA; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SVI, Social Vulnerability Index.
Figure 4.
Figure 4.
mRNA COVID-19 vaccine effectiveness against laboratory-confirmed COVID-19-associated hospitalization by SVI quartile, vaccine doses and timing, and SARS-CoV-2 subvariant era. Abbreviations: COVID-19, coronavirus disease 2019; mRNA, messenger RNA; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SVI, Social Vulnerability Index.
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