Racial, Ethnic, and Rural Disparities in US Veteran COVID-19 Vaccine Rates

Area of Science:

• Health Services Research
• Epidemiology
• Health Equity

Background:

• Disparities in coronavirus disease 2019 (COVID-19) vaccine uptake have been noted across various demographics in the United States.
• The Department of Veterans Affairs (VA) is the largest integrated healthcare system in the US, serving a diverse patient population.

Purpose of the Study:

• To investigate whether race, ethnicity, and rurality-related disparities in COVID-19 vaccine uptake exist among patients within the VA healthcare system.
• To compare vaccination likelihood across different racial/ethnic groups and urban/rural settings within the VA.

Main Methods:

• A retrospective cohort study utilizing VA Corporate Data Warehouse data from 5,871,438 patients with at least one primary care visit in 2019.
• Analysis of time-to-first COVID-19 vaccination between December 15, 2020, and June 15, 2021, considering covariates such as age, sex, race/ethnicity, rurality, and comorbidities.
• Hazard ratios were calculated to compare vaccination likelihood across demographic groups relative to a reference group (non-Hispanic White urban Veterans).

Main Results:

• Vaccinated patients (55.2%) were older, more likely to be Black, Hispanic, or Asian American/Pacific Islander (AA/PI), and more likely to reside in urban settings compared to unvaccinated patients.
• Urban Black, Hispanic, and AA/PI Veterans had an increased likelihood of vaccination compared to urban White Veterans.
• Rural Veterans, particularly White, Hispanic, AA/PI, and American Indian/Alaskan Native (AI/AN) groups, demonstrated a lower likelihood of vaccination compared to urban White Veterans, with AI/AN groups showing the lowest uptake regardless of location.

Conclusions:

• Significant disparities in COVID-19 vaccine uptake were observed within the VA system, influenced by both race/ethnicity and rurality.
• Urban minority Veterans were more likely to be vaccinated, whereas rural Veterans from most racial/ethnic groups faced barriers to vaccination.
• Understanding these disparities is crucial for developing targeted strategies to improve equitable vaccine distribution and uptake in underserved populations.