Impact of healthcare capacity disparities on the COVID-19 vaccination coverage in the United States

Keywords: COVID-19, Vaccine uptake, Healthcare capacity, Underserved communities, Social Vulnerability, United States
Abstract Type: Paper Abstract

Abstract

As of October 2022, the COVID-19 pandemic has infected a total of 97,063,357 persons in the US with 1,065,152 deaths reported. Vaccination efforts to combat the pandemic has resulted on 68% of the US population being fully vaccinated. However, when examined at lower scales, differences are noticeable: while some areas have achieved full vaccination for more than 80% of their total population, other regions still lag with rates below 50%. In this study, we identified areas with low COVID-19 vaccination coverage in the US. The spatial structure of vaccination uptake was analyzed using a spatial scan statistical analysis of cumulative vaccination at county level as of March 2022. We used scan statistics to identify geographical locations where the number of fully vaccinated individuals was lower than expected, corresponding to vaccination coldspots. The strength of the clustering was estimated using the relative risk within the cluster versus outside the cluster.

We identified 38 clusters with low vaccination rates distributed mainly on 17 states. These states also ranked at the bottom for healthcare access, healthcare quality, and public health in the US, with 12 of these falling below the national poverty rate. At county level, 71.5% of the counties inside vaccination coldspots were classified as rural. Results suggest that funding and infrastructure of the healthcare system, particularly in rural underserved areas, should be intensified to help vulnerable communities achieve vaccination targets.