Individual and Environmental Correlations with Vaccination Status in Canada: The COHESION study

Despite the importance of vaccination, some individuals are not vaccinated due to multiple factors. This study expands on previous research by incorporating elements of the physical and social neighborhood to depict vaccination profiles based on urbanization degree, identifying additional correlations with COVID-19 vaccination status and offering a fresh perspective on this complex issue. This study used three datasets: the COHESION cohort's second phase, which is a comprehensive Canadian COVID-19 dataset, encompassing demographic and socioeconomic variables; and the CANUE and StatCan datasets for environmental and neighborhood metrics. Fully adjusted modified Poisson regression and stratified modeling by urbanization degree were applied to assess the association between individual and environmental variables and vaccination status. Among 18,355 participants, 3784 were non-vaccinated. Non-vaccination was highest in rural areas (29.51%) and lowest in large urban centers (15.18%). It was also lower among youth, higher in middle-aged groups (up to 50 years), and lower again in older age groups. Higher trust in health authorities was associated with lower prevalence of non-vaccination (PR: 0.31, 95% CI [0.30-0.33]), while being from visible minority groups was associated with higher prevalence (PR: 1.14, 95% CI [1.05-1.24]). High income and student status were linked to lower non-vaccination prevalence (PR: 0.91, 95% CI [0.85-0.97] and PR: 0.80, 95% CI [0.66-0.97]). Left-leaning individuals had lower prevalence of being non-vaccinated (PR: 0.61, 95% CI [0.56-0.68]). Interestingly, the impact of greenness varied by area type. More greenness in rural areas was associated with nearly twofold higher prevalence of non-vaccination in rural areas. Our analysis reveals the complex interplay of various factors influencing COVID-19 vaccination decisions, emphasizing the importance of residential areas and urbanization. Understanding non-vaccinated profiles can help public health authorities develop targeted interventions. Individuals in remote and rural areas may face unique challenges in accessing healthcare and information, necessitating tailored interventions for these hard-to-reach areas. These associations should be interpreted cautiously, as they likely reflect context-specific structural factors rather than causal effects.