Sociodemographic Factors Associated with COVID-19 Vaccination among People in Guatemalan Municipalities

Abstract

The Republic of Guatemala's reported COVID-19 vaccination coverage is among the lowest in the Americas and there are limited studies describing the disparities in vaccine uptake within the country. We performed a cross-sectional ecological analysis using multi-level modeling to identify sociodemographic characteristics that were associated with low COVID-19 vaccination coverage among Guatemalan municipalities as of 30 November 2022. Municipalities with a higher proportion of people experiencing poverty (β = -0.25, 95% CI: -0.43--0.07) had lower vaccination coverage. Municipalities with a higher proportion of people who had received at least a primary education (β = 0.74, 95% CI: 0.38-1.08), children (β = 1.07, 95% CI: 0.36-1.77), people aged 60 years and older (β = 2.94, 95% CI: 1.70-4.12), and testing for SARS-CoV-2 infection (β = 0.25, 95% CI: 0.14-0.36) had higher vaccination coverage. In the simplified multivariable model, these factors explained 59.4% of the variation in COVID-19 vaccination coverage. Poverty remained significantly associated with low COVID-19 vaccination coverage in two subanalyses restricting the data to the time period of the highest national COVID-19-related death rate and to COVID-19 vaccination coverage only among those aged 60 years or older. Poverty is a key factor associated with low COVID-19 vaccination and focusing public health interventions in municipalities most affected by poverty may help address COVID-19 vaccination and health disparities in Guatemala.

Keywords: COVID-19 vaccination; Guatemala; equity.

Figure 1

Guatemalan municipalities by percent of primary COVID-19 vaccination series coverage versus (A) percent of municipality population of Mayan identity, (B) percent of municipality population living in a rural area, and (C) percent of municipality population experiencing poverty. Labeled municipalities are those with >70% completed COVID-19 vaccination (green dashed line) and >50% of the Mayan population (A), rural residence (B), or people experiencing poverty (C) (gray dashed line).

Figure 2

Primary COVID-19 vaccination series coverage by municipality in Guatemala. Image adapted from Guatemala Ministry of Health and Social Assistance, 25 February 2021 to 30 November 2022 [11].