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. 2023 Aug 10:11:1243958.
doi: 10.3389/fpubh.2023.1243958. eCollection 2023.

Racial and ethnic disparities in COVID-19 booster vaccination among U.S. older adults differ by geographic region and Medicare enrollment

Kaleen N Hayes  1   2 , Daniel A Harris  1   2 , Andrew R Zullo  1   2   3   4 , Preeti Chachlani  1   2 , Katherine J Wen  1   2   5 , Renae L Smith-Ray  6 , Djeneba Audrey Djibo  7 , Ellen P McCarthy  8   9 , Alexander Pralea  1 , Tanya G Singh  6 , Cheryl McMahill-Walraven  7 , Michael S Taitel  6 , Yalin Deng  2 , Stefan Gravenstein  1   2   4   10 , Vincent Mor  1   2   4
Affiliations

Racial and ethnic disparities in COVID-19 booster vaccination among U.S. older adults differ by geographic region and Medicare enrollment

Kaleen N Hayes et al. Front Public Health. .

Abstract

Introduction: COVID-19 booster vaccines are highly effective at reducing severe illness and death from COVID-19. Research is needed to identify whether racial and ethnic disparities observed for the primary series of the COVID-19 vaccines persist for booster vaccinations and how those disparities may vary by other characteristics. We aimed to measure racial and ethnic differences in booster vaccine receipt among U.S. Medicare beneficiaries and characterize potential variation by demographic characteristics.

Methods: We conducted a cohort study using CVS Health and Walgreens pharmacy data linked to Medicare claims. We included community-dwelling Medicare beneficiaries aged ≥66 years who received two mRNA vaccine doses (BNT162b2 and mRNA-1273) as of 8/1/2021. We followed beneficiaries from 8/1/2021 until booster vaccine receipt, death, Medicare disenrollment, or end of follow-up (12/31/2021). Adjusted Poisson regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) comparing vaccine uptake between groups.

Results: We identified 11,339,103 eligible beneficiaries (mean age 76 years, 60% female, 78% White). Overall, 67% received a booster vaccine (White = 68.5%; Asian = 67.0%; Black = 57.0%; Hispanic = 53.3%). Compared to White individuals, Black (RR = 0.78 [95%CI = 0.78-0.78]) and Hispanic individuals (RR = 0.72 [95% = CI 0.72-0.72]) had lower rates of booster vaccination. Disparities varied by geographic region, urbanicity, and Medicare plan/Medicaid eligibility. The relative magnitude of disparities was lesser in areas where vaccine uptake was lower in White individuals.

Discussion: Racial and ethnic disparities in COVID-19 vaccination have persisted for booster vaccines. These findings highlight that interventions to improve vaccine uptake should be designed at the intersection of race and ethnicity and geographic location.

Keywords: 2019-nCoV vaccine; BNT162b2 vaccine; COVID-19; aged; booster vaccine; healthcare disparities; mRNA vaccines; mRNA-1273.

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Conflict of interest statement

KH has received grant funding paid directly to Brown University for collaborative research from Insight Therapeutics and Sanofi for research on complex insulin regimens. KH also serves as a consultant for the Canadian Agency for Drugs and Technologies in Health. AZ has received grant funding paid directly to Brown University by Sanofi for collaborative research on the epidemiology of infections and vaccinations among nursing home residents and infants. SG is a recipient of support from the Pfizer to study pneumococcal vaccines and from Sanofi and Seqirus to study influenza vaccines. SG also performs consulting work for Icosavax, Janssen, Merck, Moderna, Novavax, Pfizer, Sanofi, Seqirus, and Vaxart; has served on the speaker’s bureaus for Seqirus, Janssen and Sanofi; and was paid to chair data safety monitoring boards from Longeveron and SciClone. RS-R, MT, and TS are employees of Walgreens and have received funding from Moderna and Pfizer to study vaccine uptake and effectiveness. DD and CM-W are full-time employees of CVS Health and conduct work for government, public, and private organizations, including pharmaceutical companies, as part of their employment. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cumulative incidence of COVID-19 booster vaccinations by race and ethnicity.
Figure 2
Figure 2
Relative rates of booster uptake* with 95% confidence intervals compared to White beneficiaries by race and ethnicity, stratified by (A) U.S. Dept. of Health and Human Services geographic region (23) and (B) Medicare and Medicaid enrollment. “No dual”, not dual eligible for Medicaid enrollment (29); FFS, Fee-for-Service; MA, Medicare Advantage. *Rate ratios (RRs) estimated from Poisson regression models with an interaction term for race/ethnicity group * (geographic region or enrollment category) to output group-specific estimates. NB: figures depicting uptake between groups by sex, age, and urbanicity are presented in the supplement.
See this image and copyright information in PMC

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