Coverage of primary and booster vaccination against COVID-19 by socioeconomic level: A nationwide cross-sectional registry study

Abstract

High and equitable COVID-19 vaccination coverage is important for pandemic control and prevention of health inequity. However, little is known about socioeconomic correlates of booster vaccination coverage. In this cross-sectional study of all Norwegian adults in the national vaccination program (N = 4,190,655), we use individual-level registry data to examine coverage by levels of household income and education of primary (≥2 doses) and booster (≥3 doses) vaccination against COVID-19. We stratify the analyses by age groups with different booster recommendations and report relative risk ratios (RR) for vaccination by 25 August 2022. In the 18-44 y group, individuals with highest vs. lowest education had 94% vs. 79% primary coverage (adjusted RR (adjRR) 1.15, 95%CI 1.14-1.15) and 67% vs. 38% booster coverage (adjRR 1.55, 95% CI 1.55-1.56), while individuals with highest vs. lowest income had 94% vs. 81% primary coverage (adjRR 1.10, 95%CI 1.10-1.10) and 60% vs. 43% booster coverage (adjRR 1.23, 95%CI 1.22-1.24). In the ≥45 y group, individuals with highest vs. lowest education had 96% vs. 92% primary coverage (adjRR 1.02, 95%CI 1.02-1.02) and 88% vs. 80% booster coverage (adjRR 1.09, 95%CI 1.09-1.09), while individuals with highest vs. lowest income had 98% vs. 82% primary coverage (adjRR 1.16, 95%CI 1.16-1.16) and 92% vs. 64% booster coverage (adjRR 1.33, 95%CI 1.33-1.34). In conclusion, we document large socioeconomic inequalities in COVID-19 vaccination coverage, especially for booster vaccination, even though all vaccination was free-of-charge. The results highlight the need to tailor information and to target underserved groups for booster vaccination.

Keywords: Booster vaccine; COVID-19; disparity; social inequity; sociodemographic correlates; socioeconomic correlates; vaccination program; vaccine coverage; vaccine hesitancy; vaccine uptake.

Figure 1.

COVID-19 vaccination coverage for ≥ 2 doses (red bars) and ≥ 3 doses (blue bars), by highest attained education level. (a) Vaccination coverage (%) for individuals aged 18–44 y. (b) Vaccination coverage (%) for individuals aged ≥ 45 y.

Figure 2.

COVID-19 vaccination coverage for ≥ 2 doses (red bars/circles) and ≥ 3 doses (blue bars/triangles), by household income level. (a) Vaccination coverage (%) for individuals aged 18–44 y. (b) Adjusted relative risks for vaccination with associated 95% confidence intervals among individuals aged 18–44 y. (c) Vaccination coverage (%) for individuals aged ≥ 45 y. (d) Adjusted relative risks for vaccination with associated 95% confidence intervals among individuals aged ≥ 45 y.