key: cord-0709072-67tfa49f
authors: Pingali, Cassandra; Meghani, Mehreen; Razzaghi, Hilda; Lamias, Mark J.; Weintraub, Eric; Kenigsberg, Tat'Yana A.; Klein, Nicola P.; Lewis, Ned; Fireman, Bruce; Zerbo, Ousseny; Bartlett, Joan; Goddard, Kristin; Donahue, James; Hanson, Kayla; Naleway, Allison; Kharbanda, Elyse O.; Yih, W. Katherine; Nelson, Jennifer Clark; Lewin, Bruno J.; Williams, Joshua T.B.; Glanz, Jason M.; Singleton, James A.; Patel, Suchita A.
title: COVID-19 Vaccination Coverage Among Insured Persons Aged ≥16 Years, by Race/Ethnicity and Other Selected Characteristics — Eight Integrated Health Care Organizations, United States, December 14, 2020–May 15, 2021
date: 2021-07-16
journal: MMWR Morb Mortal Wkly Rep
DOI: 10.15585/mmwr.mm7028a1
sha: 6eab447bc250ea6e140d18791f893651a27d199d
doc_id: 709072
cord_uid: 67tfa49f

COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19-associated morbidity and mortality (1); however, COVID-19 vaccination coverage is lower in these groups (2). CDC used data from CDC's Vaccine Safety Datalink (VSD)* to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020-May 15, 2021. Measures of coverage included receipt of ≥1 COVID-19 vaccine dose (i.e., receipt of the first dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of the Janssen COVID-19 vaccine [Johnson & Johnson]) and full vaccination (receipt of 2 doses of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of Janssen COVID-19 vaccine). Among 9.6 million persons aged ≥16 years enrolled in VSD during December 14, 2020-May 15, 2021, ≥1-dose coverage was 48.3%, and 38.3% were fully vaccinated. As of May 15, 2021, coverage with ≥1 dose was lower among non-Hispanic Black (Black) and Hispanic persons (40.7% and 41.1%, respectively) than it was among non-Hispanic White (White) persons (54.6%). Coverage was highest among non-Hispanic Asian (Asian) persons (57.4%). Coverage with ≥1 dose was higher among persons with certain medical conditions that place them at higher risk for severe COVID-19 (high-risk conditions) (63.8%) than it was among persons without such conditions (41.5%) and was higher among persons who had not had COVID-19 (48.8%) than it was among those who had (42.4%). Persons aged 18-24 years had the lowest ≥1-dose coverage (28.7%) among all age groups. Continued monitoring of vaccination coverage and efforts to improve equity in coverage are critical, especially among populations disproportionately affected by COVID-19.

COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19-associated morbidity and mortality (1); however, COVID-19 vaccination coverage is lower in these groups (2) . CDC used data from CDC's Vaccine Safety Datalink (VSD)* to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020-May 15, 2021. Measures of coverage included receipt of ≥1 COVID-19 vaccine dose (i.e., receipt of the first dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of the Janssen COVID-19 vaccine [Johnson & Johnson] ) and full vaccination (receipt of 2 doses of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of Janssen COVID-19 vaccine). Among 9.6 million persons aged ≥16 years enrolled in VSD during December 14, 2020-May 15, 2021, ≥1-dose coverage was 48.3%, and 38.3% were fully vaccinated. As of May 15, 2021, coverage with ≥1 dose was lower among non-Hispanic Black (Black) and Hispanic persons (40.7% and 41.1%, respectively) than it was among non-Hispanic White (White) persons (54.6%). Coverage was highest among non-Hispanic Asian (Asian) persons (57.4%). Coverage with ≥1 dose was higher among persons with certain medical conditions that place them at higher risk for severe COVID-19 (high-risk conditions) (63.8%) than it was among persons without such conditions (41.5%) and was higher among persons who had not had COVID-19 (48.8%) than it was among those who had (42.4%). Persons aged 18-24 years had the lowest ; persons aged 16-17 years are eligible to receive the Pfizer-BioNTech COVID-19 vaccine. ¶ All patients' records from outpatient and inpatient settings are screened by automated records review and chart review for underlying medical conditions that increase the risk for severe COVID-19, using ICD-10 codes. https://www. cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medicalconditions.html 88.3% of the VSD population; data on age, sex, high-risk condition, and history of COVID-19 illness were 100% complete. COVID-19 illness history was defined using an internal International Classification of Diseases,Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code indicating that the person had COVID-19** or a positive laboratory test result before vaccination. All analyses were performed using SAS (version 9.4; SAS Institute), and data were a census of all persons in the population (i.e., VSD); therefore, statistical tests were not performed to assess differences between groups. Absolute differences in coverage were calculated using White persons as the reference group (coverage among racial/ethnic group of interest minus coverage among White persons). This activity was reviewed by CDC and VSD sites and was conducted consistent with applicable federal law and CDC policy. † † During December 14, 2020-May 15, 2021, 9.6 million persons aged ≥16 years were continuously enrolled in VSD. The VSD population was 41.2% White, 6.5% Black, 24.2% Hispanic, 12.1% Asian, 3.3% non-Hispanic multiple or other race, 0.6% non-Hispanic Native Hawaiian or ** A combination of ICD-10 COVID-19 codes and internal medical diagnostics codes were used to identify persons with a history of COVID-19. Patient records were also screened for positive laboratory test results indicating COVID-19 before receipt of vaccination. The new ICD-10-CM code came into effect April 1, 2020. https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf † † 45 C.F.R. part 46.102(l) ( (63.8%) than among persons without these conditions (41.5%), and among persons with no history of COVID-19 (48.8%) than among those with a history of COVID-19 (42.4%) (Table) . Full vaccination coverage patterns were similar to ≥1-dose coverage by age, sex, high-risk conditions status, and history of COVID-19.

Asian persons had the highest coverage overall and among those with a high-risk condition (68.6%) or a history of COVID-19 illness (56.4%) (Figure 2 ). Among persons with and without high-risk conditions, Black persons had the lowest ≥1-dose coverage (55.6% and 30.4%, respectively).

Among persons aged ≥75 years, Black and Hispanic persons had similar ≥1-dose coverage to that of White and Asian persons; among younger age groups, ≥1-dose coverage among Black and Hispanic persons was lower than that among White and Asian persons (Supplementary Table 2 Table 3 , https://stacks.cdc.gov/view/cdc/107672).

Among 9.6 million persons in the eight integrated health care organizations from six states included in the VSD, 48.3% of those aged ≥16 years had received ≥1 COVID-19 vaccine dose as of May 15, 2021, and 38.3% were fully vaccinated; cumulative ≥1-dose coverage increased steadily during the study period for all racial and ethnic minority groups during December 14, 2020-May 15, 2021. In the VSD population, ≥1-dose COVID-19 vaccination coverage among Asian and White persons was highest, and coverage among Hispanic and Black persons was lowest. This disparity has persisted and, generally, increased since December 2020, despite increasing vaccine availability and improved outreach efforts (2) . Continued monitoring of vaccination coverage and efforts to improve equity in coverage are critical, especially among populations disproportionately affected by COVID-19. These efforts could include identifying and addressing potential barriers to access and improving vaccine acceptance, particularly among Hispanic and Black persons (3).

Coverage with ≥1 COVID-19 vaccine dose was higher among persons with a high-risk condition. This might be because such persons were prioritized for earlier allocation of COVID-19 vaccine. Persons with a history of COVID-19 had lower coverage than did persons who had not had COVID-19. This might indicate that these persons waited for some time after illness before seeking vaccination, or that they believed they might not need vaccination after recovering from COVID-19 (4). Vaccination coverage increased with increasing age. Coverage was highest among older adults, likely because of earlier vaccine prioritization among this population compared with younger adults (5) . Coverage with ≥1 COVID-19 vaccine dose was lowest among adults aged 18-24 years and among adolescents aged 16-17 years, for whom the only authorized COVID-19 vaccine is Pfizer-BioNTech. Persons aged 16-17 years are still generally under parental supervision, including with regard to medical and health decisions, which might have contributed to the higher coverage in this age group compared with that in those aged 18-24 years. Ensuring that vaccination is accessible and available in places where persons live and work could improve coverage, particularly among younger adults (6) .

The findings in this report are subject to at least three limitations. First, because VSD collects data in six states within eight integrated health care organizations, these findings might not be generalizable to the U.S. population. However, previous research indicates that VSD estimates align closely with those from the U.S. population in many important demographic characteristics, including sex and racial/ethnic distributions (7) . Second, vaccination coverage in the VSD population could be underestimated if vaccination status was not captured or identified for some persons who received vaccinations outside participating systems or state registry catchment areas. Finally,

What is already known about this topic?

Non-Hispanic Black and Hispanic persons experience higher COVID-19-associated morbidity and mortality, yet COVID-19 vaccination coverage is lower in these groups.

What is added by this report?

As of May 15, 2021, 48.3% of persons identified in CDC's Vaccine Safety Datalink aged ≥16 years had received ≥1 COVID-19 vaccine dose and 38.3% were fully vaccinated. Coverage with ≥1 dose was lower among non-Hispanic Black (40.7%) and Hispanic persons (41.1%) than among non-Hispanic White persons (54.6%); coverage was highest (57.4%) among non-Hispanic Asian persons.

What are the implications for public health practice?

Continued monitoring of vaccination coverage and efforts to improve equity in vaccination coverage are critical, especially among populations disproportionately affected by COVID-19.

VSD data on race and ethnicity are 88.3% complete, which could limit interpretation of results.

COVID-19 vaccination coverage in the integrated health systems that comprise VSD is continuing to increase for all racial/ethnic groups, and coverage is higher among persons with medical conditions that place them at higher risk for severe COVID-19. However, racial and ethnic minority groups, including Black and Hispanic persons, continue to have lower coverage, and these gaps appear to have widened over time. Although vaccines are provided at no cost, persons who have economic challenges or language barriers, lack governmentissued identification, or who face challenges because of distance or transportation to a vaccination site might experience barriers to vaccination (8) . Efforts to address vaccine misinformation, barriers to access, and insufficient vaccine confidence, coupled with strategies to prioritize equity, could help increase coverage and reduce COVID-19 incidence, especially among populations disproportionately affected by the pandemic.

Disparities in outcomes among COVID-19 patients in a large healthcare system in California

Disparities in COVID-19 vaccination rates across racial and ethnic minority groups in the United States

Ensuring equity in COVID-19 vaccine distribution

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The Advisory Committee on Immunization Practices' updated interim recommendation for allocation of COVID-19 vaccine-United States

The community guide: vaccination. Atlanta, GA: US Department of Health and Human Services, CDC; 2020

Demographic characteristics of members of the Vaccine Safety Datalink (VSD): a comparison with the United States population

Family Foundation. KFF COVID-19 Vaccine Monitor: COVID-19 vaccine access, information, and experiences among Hispanic adults in the

Julia Falvey, Leidos, Inc.; Vaccine Safety Datalink sites, project managers, and data managers; National Center for Immunization and Respiratory Diseases Data Science Team; Cindy Weinbaum. All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. James Donahue reports grants from Janssen Global Services, LLC, outside the submitted work. Nicola P.Klein reports grants from Pfizer, Merck, GlaxoSmithKline, Sanofi Pasteur, and Protein Sciences (now Sanofi Pasteur), outside the submitted work. Allison Naleway reports grants from Pfizer, outside the submitted work. Jennifer Clark Nelson reports grants from Moderna and GlaxoSmithKline, outside the submitted work. No other potential conflicts of interest were disclosed.