Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Albrecht D. Vaccination, politics and COVID-19 impacts. BMC Public Health. 2022;22(1):96. doi: 10.1186/s12889-021-12432-x. 2022/01/14. - DOI - PMC - PubMed
    1. Association of University Centers on Disabilities . 2021. COVID-19 vaccination challenges for people with disabilities [press release]. AUCD.https://www.aucd.org/docs/AUCD_COVID-19%20Vaccination%20Challenges%20for...
    1. Bailey Z.D., Krieger N., Agenor M., Graves J., Linos N., Bassett M.T. Structural racism and health inequities in the USA: Evidence and interventions. Lancet. 2017;389(10077):1453–1463. doi: 10.1016/S0140-6736(17)30569-X. - DOI - PubMed
    1. Barry V., Dasgupta S., Weller D.L., Kriss J.L., Cadwell B.L., Rose C.…Black C.L. Patterns in COVID-19 vaccination coverage, by social vulnerability and urbanicity – United States, december 14, 2020-may 1, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(22):818–824. doi: 10.15585/mmwr.mm7022e1. - DOI - PMC - PubMed
    1. Barry K., Suskin J.A., Testa J., Leonard M., De Groot A.S. Expanding access to COVID-19 testing, vaccination and treatment at a free clinic for uninsured Spanish-speaking adults in Providence, RI. Human Vaccines & Immunotherapeutics. 2022 doi: 10.1080/21645515.2022.2144604. - DOI - PMC - PubMed

LinkOut - more resources