key: cord-0799994-fpa10gyf
authors: Saluja, Sonali; Nok Lam, Chun; Wishart, Danielle; McMorris, Alec; Cousineau, Michael; Kaplan, Cameron
title: Disparities in COVID-19 Vaccine Hesitancy among Los Angeles County Adults After Vaccine Authorization
date: 2021-09-03
journal: Prev Med Rep
DOI: 10.1016/j.pmedr.2021.101544
sha: 33d5d6ac60503dc01d8b2e82e7319864cca86606
doc_id: 799994
cord_uid: fpa10gyf

An equitable COVID-19 vaccine rollout is a necessary piece of the public health strategy to end the current pandemic; however, vaccine hesitancy may present a major hurdle. This study examines racial/ethnic and income-based disparities in vaccine hesitancy in Los Angeles County, a recent epicenter of the pandemic in the US, immediately after the Food and Drug Administration issued its emergency use authorization of a COVID-19 vaccine. We conducted online, stratified cross-sectional surveys of 1,984 adults living in Los Angeles County between December 2020 and January 2021 to assess hesitancy towards getting a COVID-19 vaccine. We used multivariable logistic regression to predict vaccine hesitancy after adjusting for covariates and calculated weighted population level estimates of hesitancy and reasons for hesitancy. Blacks and Hispanics were significantly more likely to be hesitant than Whites (AOR=3.3, P<0.001; AOR=2.1, P=0.008) as were those in the lowest income group (annual income <$20,000 compared to >$100,000) (AOR=1.8, P=0.009). Additionally, those having no confidence in doing things online (AOR=3.3, P<0.001) were less likely to accept the vaccine than those who were confident. Compared to hesitant White respondents, Black respondents had higher mistrust of the government (36.1% vs 22.1%, P=0.03) and Black and Hispanic respondents were more likely to want to wait to see how the vaccine works (41.2% and 42.0% vs 27.3%, P=0.02 and P=0.006). Our study suggests that culturally appropriate messaging that addresses concerns for lower income and racial/ethnic minority communities, as well as alternatives to online vaccine appointments, are necessary for improving vaccine rollout.

1 Abstract: 2 An equitable COVID-19 vaccine rollout is a necessary piece of the public health strategy 3 to end the current pandemic; however, vaccine hesitancy may present a major hurdle. This study 4 examines racial/ethnic and income-based disparities in vaccine hesitancy in Los Angeles County, 5 a recent epicenter of the pandemic in the US, immediately after the Food and Drug 6 Administration issued its emergency use authorization of a COVID-19 vaccine. We conducted 7 online, stratified cross-sectional surveys of 1,984 adults living in Los Angeles County between 8 December 2020 and January 2021 to assess hesitancy towards getting a COVID-19 vaccine. We 9 used multivariable logistic regression to predict vaccine hesitancy after adjusting for covariates 10 and calculated weighted population level estimates of hesitancy and reasons for hesitancy.

Blacks and Hispanics were significantly more likely to be hesitant than Whites (AOR=3. 3, 12 P<0.001; AOR=2.1, P=0.008) as were those in the lowest income group (annual income 13 <$20,000 compared to >$100,000) (AOR=1. 8 

At the start of the new year, Los Angeles County was the pandemic's epicenter; cases 24 rose steeply and over 200 people were dying each day from COVID-19. 1 Racial/ethnic minority 25 groups and lower-income persons in Los Angeles were more likely to contract, become 26 hospitalized and die from COVID-19. 2 During this surge, the Food and Drug Administration also 27 issued its first emergency use authorization for a COVID-19 vaccine. 3 Though the vaccine 28 rollout is underway, public health officials are still trying to understand how to improve vaccine 29 acceptance rates in communities hardest hit by the pandemic. 4 Previous studies report significant The survey instrument included questions that were based on validated questions from 47 the National Health Interview Survey, 8 the Behavioral Risk Factor Surveillance System, 9 the 48 PhenX toolkit, 10 as well as questions proposed by our research team (Supplement). Questions 49 were pre-tested in Spanish and English and modified to improve comprehension and 50 understandability. We asked participants Would you be willing to get the COVID-19 once it is 51 available and defined vaccine hesitancy as "probably" or "definitely" not on a 4-item scale.

Vaccine hesitant respondents were asked why they were unwilling to get vaccinated. Participants 53 provided demographic information and were asked about their health, risk factors for acquiring 54 or having severe COVID-19, access to care, intention to get a flu vaccine, political preferences, 55 and comfort with doing things online. 11 We used multivariable logistic regression models to However, the disparities and high rates of vaccine hesitancy we observed may be 107 reversible. Given that the majority of hesitant individuals said they were "probably" as opposed 108 to "definitely" not willing to accept the vaccine; and many wanted to "wait and see how the .0) <0.001 Abbreviations, OR, odds ratio; AOR, adjusted odds ratio a Vaccine Hesitancy is defined as "no, probably not" or "no, definitely not willing" to get the COVID-19 vaccine once it is available vs "yes, probably" or "yes, definitely" b The adjusted odds ratio test uses a multivariable regression model which controls for covariates listed in this table and US born, household size of 4 or more people, favorability of Donald Trump, health insurance type, having a regular doctor/clinic, self-rated health status, education level, worked outside the home during the past week, intent to receive a flu vaccine, week survey was taken and the respondent's geographic region in Los Angeles County (Service Planning Area). c Black race includes 55 respondents who also self-identified as Hispanic ethnicity. Other race includes non-Hispanic respondents who self-identified as American Indian, Alaska Native, Native Hawaiian, other Pacific Islander or other race. d Highest risk conditions (any selected): obesity (body mass index of 30 or higher), smoking, pregnancy, heart disease, cancer, chronic kidney disease, chronic obstructive pulmonary disease, sickle cell disease, or diabetes. e Possibly higher risk conditions (any selected, without selecting any highest risk conditions): high blood pressure or hypertension, overweight (body mass index of 25 or higher), asthma, cystic fibrosis, weakened immune system, liver disease. 

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FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine. Food and Drug Administration

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Other race includes non-Hispanic respondents who self-identified as American Indian, Alaska Native, Native Hawaiian, other Pacific Islander or other race

Race/Ethnic group significantly different from non-Hispanic White group

Highest risk conditions (any selected): obesity (body mass index of 30 or higher), smoking, pregnancy, heart disease, cancer, chronic kidney disease, chronic obstructive pulmonary disease, sickle cell disease