Disparities in Recombinant Zoster Vaccine Coverage in the United States

Recombinant zoster vaccine (RZV) was recommended in 2020 in the US for adults aged ≥50 years. This retrospective study used cross-sectional data from 2020 National Health Interview Survey respondents aged ≥50 years. Sample weights were applied to allow results to be representative of the non-institutionalized US population. Associations between respondent characteristics and coverage were explored using logistic regression. An estimated 14.1% of US adults aged ≥50 years had received ≥1 dose of RZV by 2020. Coverage varied by race and ethnicity (6.3% Hispanic, 6.9% Black/African American, 13.7% Asian, 16.6% White), education (6.9% for grade 1-11 to 24.1% with master's degrees), household income (8.8% for <$35,000 to 18.8% for ≥$100,000), age (7.3%, 14.6%, 19.9%, and 18.1% for ages 50-59, 60-64, 65-74, and ≥75 years, respectively), health insurance (2.2% without, 14.8% with), recency of last health visit (1.8% if >3 years prior to 15.1% if <1 year), and receipt of influenza vaccine in the past year (3.9% without, 21.1% with) (all P < 0.001). In multivariable analysis, factors associated with lower RZV coverage included Black/African American race, Hispanic ethnicity, age 50-59 years, lower household income, less recent last health visit, and no influenza vaccination. In conclusion, only 1-in-7 non-institutionalized Americans aged ≥50 years reported RZV coverage by 2020, with significant disparities among subgroups defined by race and ethnicity, age, and levels of educational attainment, income, and insurance. These results highlight an opportunity to improve herpes zoster protection through increased vaccination, pursued in a more equitable manner. [Figure: see text].