Reconsidering inequalities in COVID-19 vaccine uptake in Germany: a spatiotemporal analysis combining individual educational level and area-level socioeconomic deprivation

Abstract

Combining the frameworks of fundamental causes theory and diffusion of innovation, scholars had anticipated a delayed COVID-19 vaccination uptake for people in lower socioeconomic position depending on the socioeconomic context. We qualify these propositions and analyze educational differences in COVID-19 vaccination status over the first ten months of Germany's vaccination campaign in 2021. Data from the study "Corona Monitoring Nationwide" (RKI-SOEP-2), collected between November 2021 and February 2022, is linked with district-level data of the German Index of Socioeconomic Deprivation (GISD). We estimated the proportion of people with at least one vaccination dose stratified by educational groups and within different settings of regional socioeconomic deprivation at three time points. Logistic multilevel regression models were applied to adjust for multiple covariates and to test cross-level-interactions between educational levels and levels of area-level socioeconomic deprivation. Vaccination rates were lower among respondents with lower education. With increasing area-level socioeconomic deprivation, educational differences were larger due to particularly low vaccination rates in groups with low education levels. The analysis of vaccination timing reveals that educational gaps and gaps by area-level socioeconomic deprivation had appeared early in the vaccination campaign and did not close completely before the 4th wave of COVID-19 infections.

Keywords: COVID-19; Diffusion of Innovation; Regional disparities; Social Deprivation; Socioeconomic factors; Vaccine uptake.

Fig. 1

Education-specific reverse Kaplan—Meier survival curves for first vaccination by area-level socioeconomic deprivation over calendar weeks in 2021 (a – Prioritization removal, b – 3G Rule, c – Field start).

Fig. 2

Predicted probabilities for having received at least 1 vaccine dose at three time points (with 95% confidence intervals, based on Models 1b, 2b, and 3b of Table  3).