Who’s Vaccinated? A Closer Look at Healthcare Workers’ COVID-19 Vaccine Hesitancy and Demographics

Abstract Objective: To compare COVID-19 vaccine hesitancy among hospital employees by demographics. Methods: Our institution has offered an mRNA COVID-19 vaccine to all employees since January 2021. We collected data on vaccination rates among hospital employees and looked for differences in demographic groups to determine in which groups vaccine hesitancy is the highest. Those who received at least one dose of vaccine were considered “vaccinated” for this study. Results: There was a 71% vaccination rate among all hospital employees as of March 10, 2021. Age over 50 (odds ratio 1.85, 95% CI 1.53 to 2.24, p<0.01), working in a clinical department (odds ratio 1.19, 95% CI 1.01 to 1.42, p = 0.02), and white race compared to black/African American race (odds ratio 4.55, 95% CI 3.74 to 5.52, p<0.01) were all significant factors for receiving vaccination. Gender (odds ratio 1.12, 95% CI 0.94 to 1.35, p=0.10) was not significant. Conclusions: In a population with equal access to the COVID-19 vaccine, there were significant differences in vaccination rates among different demographic groups. Employees under 50 years of age, non-clinical employees, and black/African American employees were less likely to be vaccinated. This suggests that attitudes towards vaccination, and not simply access to the vaccine, are factors in vaccination rates.

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Impact of SARS-CoV-2 Vaccines on Covid-19 Incidence and Mortality in the United States

10.1101/2021.11.16.21266360 ◽

2021 ◽

Author(s):

Fang Fang ◽

John David Clemens ◽

Zuo-Feng Zhang ◽

Timothy F. Brewer

Keyword(s):

Negative Binomial ◽

Herd Immunity ◽

The United States ◽

Vaccination Rate ◽

Vaccine Hesitancy ◽

Percentage Increase ◽

Protective Effects ◽

Vaccination Rates ◽

Incidence And Mortality ◽

Before And After

Background: Despite safe and effective vaccines to prevent Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infections and disease, a substantial minority of the US remains resistant to getting vaccinated. It is imperative to know if expanding vaccination rates could reduce community-wide Coronavirus 2019 (COVID-19) disease, not just among those vaccinated. Methods: Negative binomial models were used to estimate associations between U.S. county-level vaccination rates and county-wide COVID-19 incidence and mortality between April 23rd and September 30th, 2021. A two-week lag and a four-week lag were introduced to assess vaccination rate impact on incidence and mortality, respectively. Stratified analyses were performed for county vaccination rates >40%, and before and after Delta became the dominant variant. Findings: Among 3,070 counties, each percentage increase in population vaccination rates reduced county-wide COVID-19 incidence by 0.9% (relative risk (RR) 0.9910 (95% CI: 0.9869, 0.9952)) and mortality by 1.9% (RR 0.9807 (95% CI: 0.9745, 0.9823)). Among counties with vaccination coverage >40%, each percentage increase in vaccination rates reduced COVID-19 disease by 1.5%, RR 0.9850 (95% CI: 0.9793, 0.9952) and mortality by 2.7% (RR 0.9727 (95% CI: 0.9632, 0.9823)). These associations were not observed among counties with <40% vaccination rates. Increasing vaccination rates from 40% to 80% would have reduced COVID-19 cases by 45.4% (RR 0.5458 (95% CI: 0.4335, 0.6873)) and deaths by 67.0% (RR 0.3305 (95% CI: 0.2230, 0.4898)). An estimated 5,989,952 COVID-19 cases could have been prevented and 127,596 lives saved had US population vaccination rates increased from 40% to 80%. Interpretations: Increasing U.S. SARS-CoV-2 vaccination rates results in population-wide reductions in COVID-19 incidence and mortality. Furthermore, increasing vaccination rates above 40% has protective effects among non-vaccinated persons. Given ongoing vaccine hesitancy in the U.S., increasing vaccination rates could better protect the entire community and potentially reach herd immunity. Funding: National Cancer Institute

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Underlying factors that influence the acceptance of COVID-19 vaccine in a country with a high vaccination rate

10.1101/2021.10.31.21265676 ◽

2021 ◽

Author(s):

Daniela Toro-Ascuy ◽

Nicolas Cifuentes-Munoz ◽

Andrea Avaria ◽

Camila Pereira-Montecinos ◽

Gilena Cruzat ◽

...

Keyword(s):

Policy Design ◽

Vaccination Rate ◽

Vaccine Hesitancy ◽

Willingness To Accept ◽

Vaccination Programs ◽

Individual Level ◽

Explanatory Variables ◽

Vaccination Rates ◽

Process Understanding ◽

Nationally Representative

Control of the COVID-19 pandemic largely depends on the effectiveness of the vaccination. Several factors including vaccine hesitancy can affect the vaccination process. Understanding the factors that underlie the willingness to accept vaccination brings pivotal information to control the pandemic. We analyzed the association between the willingness level to accept the COVID-19 vaccine, and vaccine determinants amidst the Chilean vaccination process. Individual-level survey data was collected from nationally representative samples of 744 respondents, and multivariate regression models used to estimate the association between outcome and explanatory variables. Trust in the COVID-19 vaccine, scientists, and medical professionals were found to increase the willingness to: accept the vaccine, a booster dose, annual vaccination, and children vaccination. Our results are critical to understanding the acceptance of COVID-19 vaccines in the context of a country with one of the highest vaccination rates in the world. We provide information for decision-making, policy design and communication of vaccination programs.

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Disparities in Telemedicine Access: A Cross-Sectional Study of a Newly Established Infrastructure during the COVID-19 Pandemic

Applied Clinical Informatics ◽

10.1055/s-0041-1730026 ◽

2021 ◽

Vol 12 (03) ◽

pp. 445-458

Author(s):

Vivian Hsiao ◽

Thevaa Chandereng ◽

Robin L. Lankton ◽

Jeffrey A. Huebner ◽

Jeffrey J. Baltus ◽

...

Keyword(s):

African American ◽

Health Care Access ◽

Digital Literacy ◽

Geographic Region ◽

Secondary Outcome ◽

Primary Study ◽

Patient Portal ◽

Cross Sectional ◽

Black African ◽

African American Race

Abstract Background The COVID-19 pandemic led to dramatic increases in telemedicine use to provide outpatient care without in-person contact risks. Telemedicine increases options for health care access, but a “digital divide” of disparate access may prevent certain populations from realizing the benefits of telemedicine. Objectives The study aimed to understand telemedicine utilization patterns after a widespread deployment to identify potential disparities exacerbated by expanded telemedicine usage. Methods We performed a cross-sectional retrospective analysis of adults who scheduled outpatient visits between June 1, 2020 and August 31, 2020 at a single-integrated academic health system encompassing a broad range of subspecialties and a large geographic region in the Upper Midwest, during a period of time after the initial surge of COVID-19 when most standard clinical services had resumed. At the beginning of this study period, approximately 72% of provider visits were telemedicine visits. The primary study outcome was whether a patient had one or more video-based visits, compared with audio-only (telephone) visits or in-person visits only. The secondary outcome was whether a patient had any telemedicine visits (video-based or audio-only), compared with in-person visits only. Results A total of 197,076 individuals were eligible (average age = 46 years, 56% females). Increasing age, rural status, Asian or Black/African American race, Hispanic ethnicity, and self-pay/uninsured status were significantly negatively associated with having a video visit. Digital literacy, measured by patient portal activation status, was significantly positively associated with having a video visit, as were Medicaid or Medicare as payer and American Indian/Alaskan Native race. Conclusion Our findings reinforce previous evidence that older age, rural status, lower socioeconomic status, Asian race, Black/African American race, and Hispanic/Latino ethnicity are associated with lower rates of video-based telemedicine use. Health systems and policies should seek to mitigate such barriers to telemedicine when possible, with efforts such as digital literacy outreach and equitable distribution of telemedicine infrastructure.

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COVID-19 Vaccination Rates Are Lowest among Political Outsiders in the United States

10.31235/osf.io/hy7gx ◽

2021 ◽

Author(s):

Byungkyu Lee ◽

James Chu

Keyword(s):

United States ◽

Presidential Elections ◽

The United States ◽

Vaccination Rate ◽

Longitudinal Survey ◽

Vaccine Hesitancy ◽

Vaccination Rates ◽

Longitudinal Survey Data ◽

Nationally Representative ◽

The U.S

Vaccine hesitancy is a critical barrier to widespread vaccination uptake and containment of the COVID-19 pandemic. In the United States, vaccines have become politically polarized, with high rates of vaccine hesitancy observed among Republicans. In contrast to prior research focusing on partisan gaps, we investigate vaccination attitudes and uptake among a group overlooked in prior research: those who are eligible to vote but did not register in the presidential elections. Drawing on nationally representative and longitudinal survey data from April 2020 to October 2021, we show that this group – whom we call “political outsiders” – represents about 16% of the U.S. population. They had the lowest vaccination rate (47%) by 2021 October, significantly lower than Republican (65%), Independent (76%), and Democratic voters (88%). Further, we find that political outsiders are less likely to trust physicians compared to other partisan groups. Because the sources they trust differ from partisans, existing public health messaging may be less likely to reach them successfully. Finally, we find that political outsiders experience more socio-economic hardships and are less integrated into society. Hence, our results underscore the importance of targeted efforts to reach this highly vulnerable population.

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Predictors of COVID-19 Vaccination Campaign Success: Lessons Learnt from the Pandemic So Far. A Case Study from Poland

Vaccines ◽

10.3390/vaccines9101153 ◽

2021 ◽

Vol 9 (10) ◽

pp. 1153

Author(s):

Marcin Piotr Walkowiak ◽

Dariusz Walkowiak

Keyword(s):

Voter Turnout ◽

Vaccination Campaign ◽

Vaccination Rate ◽

Vaccine Hesitancy ◽

Vaccination Rates ◽

Political Views ◽

Key Factor ◽

Underlying Causes

The high effectiveness of a vaccination-promotion campaign, which may be measured by the number of those successfully convinced to get vaccinated, is a key factor in combating the COVID-19 pandemic. This, however, appears to be linked to the precise identification of the underlying causes for vaccine hesitancy behaviours. Based on a regression model (adjusted R2 of 0.78) analysing 378 sub-regions of Poland, we showed that such behaviours, even when going against the party agenda, can be indirectly yet precisely gauged predominantly through voting patterns. Additionally, education and population density were found to be positively related to low vaccine hesitancy, while markers of social exclusion, both external (employment rate) and psychological (voter turnout) ones, affected it negatively. In the second, follow-up part of our study, which analyses the changes that took place in two months (adjusted R2 of 0.53), we found a further increase in vaccination rate to be positively related to the number of those already vaccinated and to the political views of the population, and negatively related to its level of education. In both cases, there was a surprisingly weak relationship between the potential markers of accessibility and vaccination rate. In spite of the known overall differences in vaccination rates for different age and sex groups, these variables did not have any additional informative value in explaining the observed regional differences.

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Socioeconomic Status and Race Outperform Concussion History and Sport Participation in Predicting Collegiate Athlete Baseline Neurocognitive Scores

Journal of the International Neuropsychological Society ◽

10.1017/s1355617717000716 ◽

2017 ◽

Vol 24 (1) ◽

pp. 1-10 ◽

Cited By ~ 21

Author(s):

Zac Houck ◽

Breton Asken ◽

James Clugston ◽

William Perlstein ◽

Russell Bauer

Keyword(s):

Socioeconomic Status ◽

African American ◽

Collegiate Athletes ◽

Older Age ◽

Football Players ◽

Black African ◽

Speed Performance ◽

History Of ◽

Concussion History ◽

African American Race

AbstractObjectives: The purpose of this study was to assess the contribution of socioeconomic status (SES) and other multivariate predictors to baseline neurocognitive functioning in collegiate athletes. Methods: Data were obtained from the Concussion Assessment, Research and Education (CARE) Consortium. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) baseline assessments for 403 University of Florida student-athletes (202 males; age range: 18–23) from the 2014–2015 and 2015–2016 seasons were analyzed. ImPACT composite scores were consolidated into one memory and one speed composite score. Hierarchical linear regressions were used for analyses. Results: In the overall sample, history of learning disability (β=−0.164; p=.001) and attention deficit–hyperactivity disorder (β=−0.102; p=.038) significantly predicted worse memory and speed performance, respectively. Older age predicted better speed performance (β=.176; p<.001). Black/African American race predicted worse memory (β=−0.113; p=.026) and speed performance (β=−.242; p<.001). In football players, higher maternal SES predicted better memory performance (β=0.308; p=.007); older age predicted better speed performance (β=0.346; p=.001); while Black/African American race predicted worse speed performance (β=−0.397; p<.001). Conclusions: Baseline memory and speed scores are significantly influenced by history of neurodevelopmental disorder, age, and race. In football players, specifically, maternal SES independently predicted baseline memory scores, but concussion history and years exposed to sport were not predictive. SES, race, and medical history beyond exposure to brain injury or subclinical brain trauma are important factors when interpreting variability in cognitive scores among collegiate athletes. Additionally, sport-specific differences in the proportional representation of various demographic variables (e.g., SES and race) may also be an important consideration within the broader biopsychosocial attributional model. (JINS, 2018, 24, 1–10)

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COVID-19 and Historic Influenza Vaccinations in the United States: A Comparative Analysis

Vaccines ◽

10.3390/vaccines9111284 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1284

Author(s):

Pranav Mirpuri ◽

Richard A. Rovin

Keyword(s):

Influenza Vaccination ◽

The United States ◽

Vaccination Rate ◽

Primary Objective ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

County Level ◽

Vaccination Rates ◽

Global Challenge ◽

Us Counties

The COVID-19 vaccination effort is a monumental global challenge. Recognizing and addressing the causes of vaccine hesitancy will improve vaccine uptake. The primary objective of this study was to compare the COVID-19 vaccination rates in US counties to historical vaccination rates for influenza in persons aged 65 and older. The secondary objective was to identify county-level demographic, socioeconomic, and political factors that influence vaccination rates. County level data were obtained from publicly available databases for comparison and to create predictive models. Overall, in US counties the COVID-19 vaccination rate exceeded influenza vaccination rates amongst those aged 65 or older (69.4.0% vs. 44%, p < 0.0001). 2690 (83.4%) of 3224 counties had vaccinated 50% or more of their 65 and older residents in the first seven months of the COVID-19 vaccination roll out. There were 467 (14.5%) of 3223 counties in which the influenza vaccination rate exceeded the COVID-19 vaccination rate. Most of these counties were in the Southern region, were considered politically “red” and had a significantly higher non-Hispanic Black resident population (14.4% vs. 8.2%, p < 0.0001). Interventions intended to improve uptake should account for nuances in vaccine access, confidence, and consider factual social media messaging, especially in vulnerable counties.

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Implementation of Routine HPV Vaccination in the Management of Recurrent Respiratory Papillomatosis

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418821695 ◽

2018 ◽

Vol 128 (4) ◽

pp. 309-315 ◽

Cited By ~ 3

Author(s):

Yin Yiu ◽

Shannon Fayson ◽

Holly Smith ◽

Laura Matrka

Keyword(s):

Hpv Vaccine ◽

Odds Ratio ◽

Financial Support ◽

Disease Burden ◽

Hpv Vaccination ◽

Vaccination Rate ◽

Recurrent Respiratory Papillomatosis ◽

Post Vaccination ◽

Vaccination Rates ◽

Before And After

Objectives: To investigate vaccine compliance and clinical outcomes after implementation of an initiative to provide the human papillomavirus (HPV) vaccine to all patients with recurrent respiratory papillomatosis (RRP). Methods: A retrospective review was performed of all adult patients treated for RRP from 2012 to 2017. Rates of HPV vaccination were evaluated before and after December 2015, when a program was established to increase compliance by educating patients and providing financial assistance toward vaccine administration. Paired sample analyses were conducted to compare intersurgical intervals (ISIs) and number of procedures per year pre- and post-vaccination. Results: Fourteen patients with RRP completed the HPV vaccine series, with 11 patients undergoing vaccination after the initiative began. The pre-initiative vaccination rate of all patients with RRP was 9.7%; post-initiative rates improved to 43.8% ( P = .004; odds ratio, 7.26). Of vaccinated patients, there were significant differences between mean pre-vaccine ISI (3.5 months) and post-vaccine ISI (12.8 months; P = .0021), as well as between number of surgical procedures performed per year before and after vaccination (2.7 vs 0.81; P = .014). After vaccination, 5 patients demonstrated no evidence of papilloma regrowth for >12 months. Conclusions: Initiatives focused on patient education and financial support can successfully boost HPV vaccination rates in an RRP patient cohort. Our research mirrors prior findings that HPV vaccination is correlated with an increase in time between procedures and a decrease in number of procedures needed per year—factors that can dramatically reduce the disease burden on patients coping with RRP.

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Strategies that make vaccination easy and promote autonomy could increase COVID-19 vaccination in those who remain hesitant.

10.1101/2021.05.19.21257355 ◽

2021 ◽

Author(s):

Ingrid Eshun-Wilson ◽

Aaloke Mody ◽

Khai Hoan Tram ◽

Cory Bradley ◽

Alexander Scheve ◽

...

Keyword(s):

Waiting Times ◽

Vaccination Campaign ◽

Vaccine Hesitancy ◽

Public Preferences ◽

Black African ◽

Vaccination Rates ◽

The Public ◽

The Us ◽

Vaccine Distribution ◽

Vaccination Campaigns

The COVID-19 vaccination campaign in the US has been immensely successful in vaccinating those who are receptive, further increases in vaccination rates however will require more innovative approaches to reach those who remain hesitant, deliberative or indifferent. Phenomena such empty mass vaccination sites and wasted vaccine doses in some regions suggest that in addition to dispelling misinformation and building trust, developing more person-centered vaccination strategies, that are modelled on what people want could further increase uptake. To inform vaccine distribution strategies that are aligned with public preferences for COVID-19 vaccination campaign features we conducted a survey and discrete choice experiment among a representative sample of 2,895 people in the US, between March 15 and March 22, 2021. We found that on average the public prioritized ease, preferring single to two dose vaccinations, vaccinating once rather than annually and reduced waiting times at vaccination sites - for some these were the primary preference drivers. Vaccine enforcement reduced overall vaccine acceptance, with a trend of increasing control aversion with increasing vaccine hesitancy, particularly among those who were young, Black/African American or Republican. These data suggest that making vaccination easy and promoting autonomy by offering the public choices of vaccination brands and locations may increase uptake, and that vaccine mandates could compromise autonomy and increase control aversion in those who are hesitant - reducing vaccination in such groups and potentially undermining the goals of COVID-19 vaccination campaigns.

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Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211034383 ◽

2021 ◽

pp. 104990912110343

Author(s):

Lauren T. Starr ◽

Connie M. Ulrich ◽

G. Adriana Perez ◽

Subhash Aryal ◽

Paul Junker ◽

...

Keyword(s):

Palliative Care ◽

African American ◽

Do Not Resuscitate ◽

Post Discharge ◽

Black African ◽

Hospitalization Cost ◽

Palliative Care Consultation ◽

Hospitalization Costs ◽

Care Consultation ◽

African American Race

Background: Palliative care consultation to discuss goals-of-care (“PCC”) may mitigate end-of-life care disparities. Objective: To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs. Methods: This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital. Results: In adjusted analyses, hospice enrollment was less likely with Medicaid (AOR = 0.59, P = 0.02). Thirty-day readmission was less likely among age 75+ (AOR = 0.43, P = 0.02); more likely with Medicaid (AOR = 2.02, P = 0.004), 30-day prior admission (AOR = 2.42, P < 0.0001), and Black/African American race (AOR = 1.57, P = 0.02). Future days hospitalized was greater with Medicaid (Coefficient = 4.49, P = 0.001), 30-day prior admission (Coefficient = 2.08, P = 0.02), and Black/African American race (Coefficient = 2.16, P = 0.01). Any future hospitalization cost was less likely among patients ages 65-74 and 75+ (AOR = 0.54, P = 0.02; AOR = 0.53, P = 0.02); more likely with Medicaid (AOR = 1.67, P = 0.01), 30-day prior admission (AOR = 1.81, P = 0.0001), and Black/African American race (AOR = 1.40, P = 0.02). Total future hospitalization costs were lower for females (Coefficient = −3616.64, P = 0.03); greater with Medicaid (Coefficient = 7388.43, P = 0.01), 30-day prior admission (Coefficient = 3868.07, P = 0.04), and Black/African American race (Coefficient = 3856.90, P = 0.04). Do-not-resuscitate documentation (48%) differed by race. Conclusions: Among PCC patients, Black/African American race and social determinants of health were risk factors for future hospitalization utilization and costs. Medicaid use predicted hospice discharge. Social support interventions are needed to reduce future hospitalization disparities.

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