Heterogeneity in the Spatial Inequities in COVID-19 Vaccination Across 16 Large U.S. Cities
Table of Contents
Table of Contents
Report Publish Date: April 22, 2022
This journal article describes a study that examines disparities in COVID-19 vaccination by ZIP code in 16 large U.S. cities.
Primary Takeaways
Vaccination levels varied widely between neighborhoods in a single city. Across the 16 cities and 866 neighborhoods studied, the authors found that neighborhoods with the highest social vulnerability had vaccination coverage 16 percentage points lower than that of neighborhoods with the lowest social vulnerability.
Levels of disparity in vaccination coverage also varied widely. In San Francisco and San Jose, Calif., the neighborhoods at the 90th percentile of vaccination coverage had 28% higher coverage than those at the 10th percentile. In Dallas, the difference was 71%.
Overview and Objectives
During the COVID-19 pandemic, the disease took a greater toll on people with lower socioeconomic status and on racial and ethnic minorities. During the vaccine rollout, some people called for prioritizing high-risk neighborhoods, but this strategy was rarely put into place.
The authors wanted to know what disparities in COVID vaccination looked like in some of the U.S.’s largest cities.
“Characterizing social and spatial inequities in cities is critical to developing appropriate interventions and policies to increase COVID-19 vaccination among underserved populations, helping control the pandemic, and reducing health disparities,” the authors write. “This is especially important in large cities, where social inequalities are more prevalent and whose high-vulnerability neighborhoods tend to bear the highest overall COVID-19 mortality burden.”
Hypothesis or Approach
The authors used data from the Big Cities Health Coalition COVID-19 Health Inequities in Cities Dashboard, covering the period from the start of vaccination to September 2021. The researchers defined neighborhoods using ZIP code tabulation areas. They used the 2018 CDC Social Vulnerability Index to describe neighborhood vulnerability.
How This Influences Change
“[T]he pandemic and our response to it has made it abundantly clear that addressing structural factors linked to income inequality, racism, and segregation will be fundamental to promoting population health and health equity across all health conditions,” the authors write.
Research: Go Deeper
Differences in vaccination coverage can perpetuate coronavirus disease 2019 (COVID-19) disparities. We explored the association between neighborhood-level social vulnerability and COVID-19 vaccination coverage in 16 large US cities from the beginning of the vaccination campaign in December 2020 through September 2021. We calculated the proportion of fully vaccinated adults in 866 zip code tabulation areas (ZCTAs) of 16 large US cities: Long Beach, Los Angeles, Oakland, San Diego, San Francisco, and San Jose, all in California; Chicago, Illinois; Indianapolis, Indiana; Minneapolis, Minnesota; New York, New York; Philadelphia, Pennsylvania; and Austin, Dallas, Fort Worth, Houston, and San Antonio, all in Texas. We computed absolute and relative total and Social Vulnerability Index–related inequities by city. COVID-19 vaccination coverage was 0.75 times (95% confidence interval: 0.69, 0.81) or 16 percentage points (95% confidence interval: 12.1, 20.3) lower in neighborhoods with the highest social vulnerability as compared with those with the lowest. These inequities were heterogeneous, with cities in the West generally displaying narrower inequities in both the absolute and relative scales. The Social Vulnerability Index domains of socioeconomic status and of household composition and disability showed the strongest associations with vaccination coverage. Inequities in COVID-19 vaccinations hamper efforts to achieve health equity, as they mirror and could lead to even wider inequities in other COVID-19 outcomes.
American Journal of Epidemiology, September 2022. https://doi.org/10.1093/aje/kwac076
Research Team
This study and report was conducted and created by the following people.
- Bilal U
- Mullachery PH
- Schnake-Mahl A
- Rollins H
- McCulley E
- Kolker J
- Barber S
- Diez Roux AV
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