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. 2023 Feb 21:22:101366.
doi: 10.1016/j.ssmph.2023.101366. eCollection 2023 Jun.

Neighborhood-level COVID vaccination and booster disparities: A population-level analysis across California

Debora L Oh  1 , Kathryn E Kemper  1   2 , Dan Meltzer  1 , Alison J Canchola  1 , Kirsten Bibbins-Domingo  1   2   3 , Courtney R Lyles  1   2   3
Affiliations

Neighborhood-level COVID vaccination and booster disparities: A population-level analysis across California

Debora L Oh et al. SSM Popul Health. .

Abstract

Objectives: To describe vaccine and booster uptake by neighborhood-level factors in California.

Methods: We examined trends in COVID-19 vaccination up to September 21, 2021, and boosters up to March 29, 2022 using data from the California Department of Public Health. Quasi-Poisson regression was used to model the association between neighborhood-level factors and fully vaccinated and boosted among ZIP codes. Sub-analyses on booster rates were compared among the 10 census regions.

Results: In a minimally adjusted model, a higher proportion of Black residents was associated with lower vaccination (HR = 0.97; 95%CI: 0.96-0.98). However, in a fully adjusted model, proportion of Black, Hispanic/Latinx, and Asian residents were associated with higher vaccination rates (HR = 1.02; 95%CI: 1.01-1.03 for all). The strongest predictor of low vaccine coverage was disability (HR = 0.89; 95%CI: 0.86-0.91). Similar trends persisted for booster doses. Factors associated with booster coverage varied by region.

Conclusions: Examining neighborhood-level factors associated with COVID-19 vaccination and booster rates uncovered significant variation within the large and geographically and demographically diverse state of California. Equity-based approaches to vaccination must ensure a robust consideration of multiple social determinants of health.

Keywords: ACS, American Community Survey; CDPH, California Department of Public Health; COVID-19; COVID-19, Coronavirus Disease 2019; Health disparities; LEP, Limited English Proficiency; Neighborhood; Population health; SDOH, Social Determinants of Health; Social determinants of health; UCSF, University of California, San Francisco; VEM, Vaccine Equity Metric; Vaccination; ZCTA, Zip Code Tabulation Area.

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Conflict of interest statement

None to declare.

Figures

Fig. 1a
Fig. 1a
Forest plots of minimally adjusted (Model 1) and fully adjusted (Model 2) quasi-Poisson models with ZCTA-level observations for all COVID-19 vaccinations reported in California up to September 21, 2021.a.
Fig. 1b
Fig. 1b
Forest plots of minimally adjusted (Model 1) and fully adjusted (Model 2) quasi-Poisson models with ZCTA-level observations for all COVID-19 boosters reported in California up to March 29, 2022.a. a Data is offset for the natural logarithm of population ≥12 years and adjusted for county.
Fig. 2a
Fig. 2a
Vaccine coverage quintiles among age 12+ across California, overlayed with Census Regions, September 21, 2021. a As of September 21, 2021; b As of March 29, 2022; c Proportion boosted among population of fully vaccinated as of March 29, 2022; d Persons per square kilometer.
Fig. 2b
Fig. 2b
Booster coverage quintiles among age 12+ across California, overlayed with Census Regions, March 29, 2022.
See this image and copyright information in PMC

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