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Spatial Accessibility and Uptake of Pediatric COVID-19 Vaccinations by Social Vulnerability

Rohan Khazanchi · Benjamin M. Rader · Jonathan Cantor · Kathleen A. McManus · Dena M Bravata · Rebecca Weintraub +2 more

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Vaccine Coverage and Hesitancy SARS-CoV-2 and COVID-19 Research COVID-19 epidemiological studies

Abstract

BACKGROUND AND OBJECTIVES: Geographic accessibility predicts pediatric preventive care utilization, including vaccine uptake. However, spatial inequities in the pediatric coronavirus disease 2019 (COVID-19) vaccination rollout remain underexplored. We assessed the spatial accessibility of vaccination sites and analyzed predictors of vaccine uptake. METHODS: In this cross-sectional study of pediatric COVID-19 vaccinations from the US Vaccine Tracking System as of July 29, 2022, we described spatial accessibility by geocoding vaccination sites, measuring travel times from each Census tract population center to the nearest site, and weighting tracts by their population demographics to obtain nationally representative estimates. We used quasi-Poisson regressions to calculate incidence rate ratios, comparing vaccine uptake between counties with highest and lowest quartile Social Vulnerability Index scores: socioeconomic status (SES), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation. RESULTS: We analyzed 15 233 956 doses administered across 27 526 sites. Rural, uninsured, white, and Native American populations experienced longer travel times to the nearest site than urban, insured, Hispanic, Black, and Asian American populations. Overall Social Vulnerability Index, SES, and HCD were associated with decreased vaccine uptake among children aged 6 months to 4 years (overall: incidence rate ratio 0.70 [95% confidence interval 0.60-0.81]; SES: 0.66 [0.58-0.75]; HCD: 0.38 [0.33-0.44]) and 5 years to 11 years (overall: 0.85 [0.77-0.95]; SES: 0.71 [0.65-0.78]; HCD: 0.67 [0.61-0.74]), whereas social vulnerability by MSL was associated with increased uptake (6 months-4 years: 5.16 [3.59-7.42]; 5 years-11 years: 1.73 [1.44-2.08]). CONCLUSIONS: Pediatric COVID-19 vaccine uptake and accessibility differed by race, rurality, and social vulnerability. National supply data, spatial accessibility measurement, and place-based vulnerability indices can be applied throughout public health resource allocation, surveillance, and research.

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References

2014Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: A systematic review of published literature, 2007–2012 2018A global map of travel time to cities to assess inequalities in accessibility in 2015 2005Neighborhood Socioeconomic Disadvantage and Access to Health Care 1998Access to Care Is the Centerpiece in the Elimination of Socioeconomic Disparities in Health 2020Framework for Equitable Allocation of COVID-19 Vaccine 2021Parents’ Intentions and Perceptions About COVID-19 Vaccination for Their Children: Results From a National Survey 2021Factors Associated With Racial/Ethnic Group–Based Medical Mistrust and Perspectives on COVID-19 Vaccine Trial Participation and Vaccine Uptake in the US 2021COVID-19–Associated Orphanhood and Caregiver Death in the United States

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