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Trends in COVID-19 vaccination receipt and intention to vaccinate, United States, April to August, 2021

2021; Elsevier BV; Volume: 50; Issue: 6 Linguagem: Inglês

10.1016/j.ajic.2021.12.022

1527-3296

Kimberly H. Nguyen, Kimchi Nguyen, Megan Geddes, Jennifer D. Allen, Laura Corlin,

COVID-19 epidemiological studies

To assess trends in and factors associated with COVID-19 vaccination coverage, data from the Household Pulse Survey were analyzed. From April to August 2021, vaccination coverage with at least 1 dose increased from 70%-82%, while vaccination intent increased from 82%-86%, with the highest increase among the most vulnerable groups. More efforts are needed to boost confidence in vaccines and to encourage all eligible people to be fully vaccinated. To assess trends in and factors associated with COVID-19 vaccination coverage, data from the Household Pulse Survey were analyzed. From April to August 2021, vaccination coverage with at least 1 dose increased from 70%-82%, while vaccination intent increased from 82%-86%, with the highest increase among the most vulnerable groups. More efforts are needed to boost confidence in vaccines and to encourage all eligible people to be fully vaccinated. In December 2020, the COVID-19 vaccine became available in the United States under an Emergency Use Authorization for groups prioritized for early vaccination and to all adults ≥18 years starting in April 20211COVID-19 ACIP Vaccine Recommendations. Centers for Disease Control and Prevention. Accessed on June 12, 2021. Available at: https://www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/covid-19.htmlGoogle Scholar; however, COVID-19 vaccination with at least 1 dose and with all recommended doses was 78% and 68%, respectively, as of October 9, 2021.2COVID-19 Vaccinations in the United States. Centers for Disease Control and Prevention. Assessed October 9, 2021. Available at: https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-totalGoogle Scholar The importance of achieving high and equitable vaccination uptake was demonstrated throughout the summer of 2021 when increasing transmission of COVID-19 variants, lagging vaccination rates, and a reduction in social distancing and other preventive measures led to rising number of cases, hospitalizations, and deaths throughout the U.S. after months of decline.3Berg, S. How lagging vaccination rates have fueled boom in COVID-19 cases. American Medical Association. Assessed September 15, 2021. Available at: https://www.ama-assn.org/delivering-care/public-health/how-lagging-vaccination-rates-have-fueled-boom-covid-19-casesGoogle Scholar Furthermore, the re-opening of schools and businesses, and increased social gatherings and travel,4Mehta SH Clipman SJ Wesolowski A Solomon SS. Holiday gatherings, mobility and SARS-CoV-2 transmission: results from 10 US states following Thanksgiving.Scientific Reports. 2021; 11: 1-9Crossref PubMed Scopus (4) Google Scholar amplify the need for increased vaccination coverage. Unfortunately, even as vaccination coverage and intent increased from January to March 2021, disparities existed by age, race and/or ethnicity, and other sociodemographic factors.5Nguyen KH. Nguyen C. Corlin L. Allen J. Chung M. Trends in COVID-19 vaccination and intent, by socioeconomic characteristics and geographic area, adults ≥ 18 years, United States, January 6 – March 29.Ann Med. 2021; 53: 1419-1428Crossref PubMed Scopus (26) Google Scholar To follow-up on these early vaccination disparities, the present study assessed trends and differences in vaccination coverage and intent from April to August 2021, and examined changes in reasons for not getting vaccinated using a large, nationally representative survey. Data from five waves (April 14-26, May 12-24, June 9-21, July 21-August 2, August 18-30, 2021) of the Household Pulse Survey were analyzed (n=343,553). The survey design of the HPS has been described previously.6Fields JF, Hunter-Childs J, Tersine A, et al. Design and Operation of the 2020 Household Pulse Survey, 2020. U.S. Census Bureau. Updated July 31, 2020. Assessed September 9, 2021. Available at: https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/2020_HPS_Background.pdfGoogle Scholar The response rates for five waves of data collection ranged from 6.1%-7.4%.7Source of the Data and Accuracy of the Estimates for the Household Pulse Survey – Phase 3.2. Census Bureau. Accessed August 15, 2021. Available at:https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/Phase3-2_Source_and_Accuracy_Week%2036.pdfGoogle Scholar This study was reviewed by the Tufts University Health Sciences Institutional Review Board and was not considered human subjects research. COVID-19 vaccination receipt (≥1 dose) was assessed by the following questions: “Have you received a COVID-19 vaccine?” [yes/no] Among unvaccinated adults, intent to be vaccinated was assessed with the question: “Once a vaccine to prevent COVID-19 is available to you, would you...definitely, probably, be unsure about, probably not, or definitely not get a vaccine.” Because measuring intent over time would show bias as more people get vaccinated, vaccination intent was defined as being vaccinated or being definitely or probably likely to get vaccinated. Among all non-vaccinated respondents who did not report that they definitely planned to get vaccinated in April and August (n=18,888), respondents were asked reasons for not getting vaccinated (Appendix). Trends in vaccination status were assessed for each survey wave overall and by socioeconomic characteristics through multivariable regression (Appendix). Factors associated with and differences in vaccination coverage and intent were examined using multivariable regression models and t-tests. Proportions and differences in reasons for not getting vaccinated were assessed. Analyses accounted for the survey design and weights to ensure a representative sample in SAS (version 9.4; SAS Institute, Inc.) and Stata (version 16.1). Receipt of ≥1 dose of a COVID-19 vaccine and intent to be vaccinated increased from April 14 to August 30, 2021 nationally and across most sociodemographic characteristics (Table 1 and Supplemental table; Supplemental figure). Vaccination coverage with at least one dose increased from 70%-82% while vaccination intent increased from 82%-86% (Table 1 and Supplemental table).Table 1Trends in and factors associated with receipt of ≥1 dose of COVID-19 vaccine among adults ≥18 years, by sociodemographic characteristics and survey week, United States, Household Pulse Survey, April 14, 2021 to August 30, 20214/14-4/265/12-5/246/9-6/217/21-8/28/18-8/308/18-8/30N = 68,913N = 72,897N = 68,067N = 64,562N = 69,114Difference%(95% CI)%(95% CI)%(95% CI)%(95% CI)%(95% CI)%(95%CI)aPR†Prevalence ratio adjusted for age, sex, race/ethnicity, educational status, annual household income, insurance status, previous COVID-19 diagnosis, and HHS region.(95%CI)All69.7(69.0, 70.3)77.3(76.7, 78.0)79.1(78.5, 79.8)82.0(81.4, 82.6)82.3(81.7, 82.9)*p-value for trend from April to August significant at <0.001.12.6(11.7, 13.5)Age Group 18-2452.6(49.8, 55.4)66.3(62.6, 70.0)71.8(68.2, 75.4)74.5(71.7, 77.3)72.2(69.3, 75.2)*p-value for trend from April to August significant at <0.001.19.6(15.5, 23.7)1.00 25-3957.4(56.1, 58.6)67.5(66.0, 69.0)69.9(68.4, 71.3)73.1(71.3, 74.9)73.6(72.3, 74.9)*p-value for trend from April to August significant at <0.001.16.2(14.4, 18.0)0.95(0.91, 0.99) 40-5466.1(64.6, 67.5)75.6(74.3, 76.8)76.9(75.6, 78.3)80.2(79.1, 81.3)80.4(79.2, 81.6)*p-value for trend from April to August significant at <0.001.14.3(12.4, 16.2)1.03(0.99, 1.08) 55-6478.4(76.7, 80.0)83.8(82.7, 85.0)85.1(83.8, 86.5)88.4(87.2, 89.5)88.4(87.3, 89.5)*p-value for trend from April to August significant at <0.001.10.0(8.0, 12.0)1.14(1.09, 1.19) 65+88.4(87.1, 89.6)90.4(89.2, 91.6)91.1(90.1, 92.2)92.8(92.1, 93.6)94.2(93.5, 94.9)*p-value for trend from April to August significant at <0.001.5.8(4.4, 7.2)1.21(1.17, 1.27)Sex Male69.2(68.1, 70.3)77.6(76.5, 78.7)79.5(78.3, 80.6)81.6(80.4, 82.7)81.3(80.2, 82.3)*p-value for trend from April to August significant at <0.001.12.1(10.6, 13.6)1.00 Female70.1(69.3, 70.9)77.1(76.2, 77.9)78.8(78.1, 79.5)82.4(81.6, 83.2)83.3(82.7, 83.9)*p-value for trend from April to August significant at <0.001.13.2(12.2, 14.2)1.01(0.99, 1.03)Race/ethnicity NH White72.2(71.6, 72.9)78.1(77.3, 78.8)79.5(78.7, 80.3)82.7(82.0, 83.5)82.9(82.3, 83.5)*p-value for trend from April to August significant at <0.001.10.7(9.8, 11.6)1.00 NH Black62.6(60.5, 64.8)70.8(68.8, 72.8)71.9(70.0, 73.9)75.7(73.4, 78.0)77.4(75.2, 79.5)*p-value for trend from April to August significant at <0.001.14.8(11.8, 17.8)1.02(0.99, 1.05) NH Asian80.2(77.2, 83.1)91.0(89.7, 92.4)94.6(93.2, 95.9)94.4(92.6, 96.2)95.7(94.3, 97.0)*p-value for trend from April to August significant at <0.001.15.5(12.3, 18.7)1.12(1.09, 1.14) NH multi/other58.9(55.4, 62.4)65.7(62.3, 69.1)68.5(65.0, 72.0)79.5(76.1, 82.9)74.4(71.6, 77.3)*p-value for trend from April to August significant at <0.001.15.5(11.0, 20.0)0.97(0.93, 1.01) Hispanic or Latino64.0(62.0, 66.1)76.6(74.5, 78.7)79.6(77.4, 81.7)80.0(77.8, 82.3)81.0(78.7, 83.2)*p-value for trend from April to August significant at <0.001.17.0(14.0, 20.0)1.09(1.07, 1.12)Educational Status Less than high school54.4(50.5, 58.3)67.1(63.0, 71.1)68.6(65.2, 71.9)70.0(66.6, 73.5)72.5(68.8, 76.2)*p-value for trend from April to August significant at <0.001.18.1(12.7, 23.5)1.00 High school diploma or GED61.3(59.8, 62.9)70.1(68.8, 71.4)71.8(70.2, 73.4)75.9(74.4, 77.4)76.0(74.6, 77.4)*p-value for trend from April to August significant at <0.001.14.7(12.6, 16.8)1.03(0.96, 1.09) Some college/associate degree68.4(67.3, 69.5)75.3(74.2, 76.4)77.5(76.5, 78.4)81.1(80.1, 82.1)81.2(80.3, 82.2)*p-value for trend from April to August significant at <0.001.12.8(11.3, 14.3)1.12(1.05, 1.17) Bachelor's degree or higher83.3(82.4, 84.2)89.1(88.6, 89.7)90.8(90.2, 91.3)92.0(91.6, 92.5)92.3(91.8, 92.7)*p-value for trend from April to August significant at <0.001.9.0(8.0, 10.0)1.21(1.15, 1.28)Annual Household Income Less than $35,00058.8(56.5, 61.0)70.9(69.0, 72.8)72.3(70.4, 74.2)74.6(72.8, 76.5)78.0(76.3, 79.6)*p-value for trend from April to August significant at <0.001.19.2(16.4, 22.0)1.00 $35,000 - $49,99970.1(67.4, 72.8)73.2(70.8, 75.5)77.2(75.1, 79.3)84.1(82.0, 86.2)83.1(81.4, 84.9)*p-value for trend from April to August significant at <0.001.13.0(9.8, 16.2)1.04(1.02, 1.07) $50,000 - $74,99973.1(70.8, 75.4)78.7(77.5, 80.0)81.0(79.3, 82.7)83.9(82.1, 85.7)85.7(84.4, 86.9)*p-value for trend from April to August significant at <0.001.12.6(10.0, 15.2)1.05(1.02, 1.07) $75,000 and above80.1(79.1, 81.0)85.4(84.5, 86.3)87.1(86.2, 88.0)90.2(89.3, 91.1)89.0(88.2, 89.8)*p-value for trend from April to August significant at <0.001.8.9(7.7, 10.1)1.06(1.03, 1.08) Did not report64.8(63.5, 66.1)73.8(72.5, 75.2)75.6(74.3, 76.9)76.2(74.7, 77.7)75.5(74.1, 76.9)*p-value for trend from April to August significant at <0.001.10.7(8.8, 12.6)0.99(0.96, 1.02)Insurance Status Covered by some type of health insurance74.6(73.8, 75.4)80.7(79.9, 81.5)82.4(81.6, 83.3)85.9(85.2, 86.6)85.8(85.2, 86.4)*p-value for trend from April to August significant at <0.001.11.2(10.2, 12.2)1.00 Not covered by any type of health insurance43.8(40.4, 47.3)59.2(55.9, 62.5)62.1(58.8, 65.3)64.5(60.8, 68.2)67.9(64.5, 71.3)*p-value for trend from April to August significant at <0.001.24.1(19.3, 28.9)0.88(0.84, 0.92)COVID-19 Status Previously diagnosed with COVID-1957.4(55.4, 59.5)65.8(63.6, 67.9)68.9(67.1, 70.7)73.3(71.5, 75.2)72.6(71.0, 74.2)*p-value for trend from April to August significant at <0.001.15.2(12.6, 17.8)0.89(0.87, 0.91) Not previously diagnosed with COVID-1972.1(71.4, 72.7)79.5(78.8, 80.1)81.1(80.5, 81.8)84.6(83.9, 85.2)85.3(84.7, 85.9)*p-value for trend from April to August significant at <0.001.13.2(12.3, 14.1)1.00HHS region ‡Health and human services regions are defined as the following: Region 1, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; Region 2, New Jersey, New York, Puerto Rico, and the Virgin Islands; Region 3, Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; Region 4, Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; Region 5, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; Region 6, Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; Region 7, Iowa, Kansas, Missouri, and Nebraska; Region 8, Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; Region 9, Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau; Region 10; Alaska, Idaho, Oregon, and Washington. 176.7(75.1, 78.3)86.4(85.0, 87.7)88.6(86.9, 90.3)90.3(88.8, 91.8)89.8(88.6, 91.1)*p-value for trend from April to August significant at <0.001.13.1(11.1, 15.1)1.00 272.2(69.1, 75.2)80.2(77.0, 83.3)81.6(79.1, 84.2)87.6(84.9, 90.2)87.2(85.1, 89.3)*p-value for trend from April to August significant at <0.001.15.0(11.3, 18.7)0.97(0.94, 0.99) 372.2(70.5, 74.0)79.6(77.6, 81.5)80.3(78.8, 81.8)85.4(83.5, 87.2)85.0(82.8, 87.1)*p-value for trend from April to August significant at <0.001.12.8(10.0, 15.6)0.97(0.95, 0.99) 463.7(62.2, 65.3)70.7(69.1, 72.3)73.1(71.3, 74.8)76.5(74.9, 78.0)76.8(75.4, 78.2)*p-value for trend from April to August significant at <0.001.13.1(11.0, 15.2)0.91(0.89, 0.93) 569.8(68.3, 71.3)78.5(77.2, 79.8)80.6(79.3, 81.9)81.9(80.2, 83.7)81.9(80.5, 83.4)*p-value for trend from April to August significant at <0.001.12.1(10.0, 14.2)0.94(0.92, 0.97) 669.0(66.3, 71.7)75.6(73.9, 77.4)76.2(73.8, 78.6)76.6(74.4, 78.8)79.5(77.8, 81.3)*p-value for trend from April to August significant at <0.001.10.5(7.3, 13.7)0.94(0.91, 0.96) 771.7(69.7, 73.6)74.9(73.0, 76.7)75.3(73.2, 77.3)80.4(78.4, 82.4)80.2(78.4, 82.0)*p-value for trend from April to August significant at <0.001.8.5(5.8, 11.2)0.93(0.91, 0.96) 870.1(68.1, 72.2)76.7(74.6, 78.7)77.7(75.7, 79.6)82.4(80.5, 84.3)83.1(81.0, 85.1)*p-value for trend from April to August significant at <0.001.13.0(10.1, 15.9)0.95(0.92, 0.99) 972.3(70.4, 74.1)81.9(80.1, 83.7)83.9(82.2, 85.6)85.9(84.6, 87.2)85.7(84.1, 87.3)*p-value for trend from April to August significant at <0.001.13.4(11.0, 15.8)0.95(0.92, 0.98) 1069.4(67.5, 71.4)75.8(73.9, 77.7)82.0(80.3, 83.7)84.7(82.8, 86.5)84.2(82.3, 86.0)*p-value for trend from April to August significant at <0.001.14.8(12.1, 17.5)0.97(0.95, 0.99)Abbreviations: aPR, adjusted prevalence ratio; CI, confidence interval. p-value for trend from April to August significant at <0.001.† Prevalence ratio adjusted for age, sex, race/ethnicity, educational status, annual household income, insurance status, previous COVID-19 diagnosis, and HHS region.‡ Health and human services regions are defined as the following: Region 1, Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont; Region 2, New Jersey, New York, Puerto Rico, and the Virgin Islands; Region 3, Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia; Region 4, Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee; Region 5, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin; Region 6, Arkansas, Louisiana, New Mexico, Oklahoma, and Texas; Region 7, Iowa, Kansas, Missouri, and Nebraska; Region 8, Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming; Region 9, Arizona, California, Hawaii, Nevada, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Marshall Islands, and Republic of Palau; Region 10; Alaska, Idaho, Oregon, and Washington. Open table in a new tab Abbreviations: aPR, adjusted prevalence ratio; CI, confidence interval. Vaccination coverage increased within each sociodemographic group, but the largest increases in coverage occurred among younger adults (18-24 years: 20 percentage points [pp]), Hispanic or Latino populations (17 pp), adults with lower levels of education (less than high school education: 18 pp) and lower income (less than $35,000: 19 pp), as well as those not covered by insurance (24 pp) (Table 1). In multivariable analyses, factors associated with vaccination coverage and intent were older age, identification with certain racial and/or ethnic minority groups, having a higher education or income, having insurance, and not having a prior COVID-19 diagnosis (Table 1 and Supplemental table). Reasons for not getting vaccinated changed from April to August, with a higher proportion of adults in August having concerns about possible side effects (from 51%-57%), lack of trust in vaccines (from 30%-44%), lack of trust in the government (from 23%-40%), and belief that the vaccine is not needed (from 20%-30%) (Fig 1). Receipt of and intention to get a COVID-19 vaccine increased from April to August 2021, particularly among groups which had the lowest vaccination coverage, suggesting that disparities in vaccination coverage and intent among vulnerable populations found early in 2021 were narrowing. Nevertheless approximately 7% of the population continue to report that they definitely will not get vaccinated, a statistic that has remained relatively unchanged since April 2021.