Income, race, and ethnical-mediated inequities in COVID-19 vaccination across major US cities

A new study shows during the first 5 months of vaccine rollout in the USA, vaccination rates were lowest in low-income, ethnic rich, and racially mixed neighborhoods, despite having the highest COVID-19 mortality.  

COVID-19 Vaccination. Image Credit: Prostock-studio/

Addressing the limited data availability on COVID-19 vaccine equity in the US

Published in the JAMA Health forum, new findings by Drs Adam Sacarny and Jamie R. Daw, demonstrate that unequal vaccination rates across US cities were largely correlated with socioeconomic factors.

The authors examined how equitable vaccine receipt was during the first 5 months when the vaccine for COVID-19 was implemented nationally. This data is often lacking on a national level due to largescale spatial and temporal factors impeding the precision of differences in data collection.

In response, the authors of the present study gathered data covering 40.8 million residents of the 9 largest cities in the USA. Data was then refined on a neighborhood level, using zip codes as identifiers, from which was then collected mortality rates and vaccination data.

Overall, 1127 neighborhoods were analyzed with an average vaccination rate of 42.3%.

Examining the differences in vaccination rate across socioeconomic factors

Neighborhoods with high vaccination rates were predominantly composed of White and Asian people and had a lower proportion of Black and Hispanic or Latino people. Economically, neighborhoods with high vaccination rates had higher mean incomes, lower poverty rates, and higher 4-year college completion rates.

From a historical perspective, the amount of COVID-19 death rates (from the first COVID-19 deaths through April 13, 2021) were lowest in neighborhoods with the highest vaccination rates despite the fact these neighborhoods had older adults who are at higher risk.

In summary, of the 863 neighborhoods that experienced mortality from COVID-19, the 209 highest death rates accounted for half of all historical COVID-19 deaths but only 26% of all vaccinations.

Addressing the discrepancies in vaccine equity and its future implications

The authors emphasize the importance of vaccine equity and highlight those socioeconomic drivers of vaccinations may represent a threat at a nationwide level. This is particularly true due to the high levels of mortality in vulnerable neighborhoods.

However, several limitations of the study are important to consider. Data collected on vaccination and death rates may not be exact since issues related to the supply and demand of vaccines were not used in the analysis. Moreover, data may not be as applicable across other major US cities, and care has to be applied when extrapolating from this data.

Nonetheless, the authors conclude that inequities in vaccination rates are most likely reflective of several causes ranging from the underinvestment in public health among segregated communities to the unequal access to healthcare services. In turn, this drives a distrust in marginalized groups, and the findings of this study highlight those further efforts are required to ensure adequate vaccination equity.

Journal reference:

  • JAMA Health Forum. 2021;2(9):e212415. doi:10.1001/jamahealthforum.2021.2415
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