Examining the Intersections of Race/Ethnicity and Rurality of Residence
on COVID-19 Vaccination Uptake
Abstract
Purpose: The objective of this study was to examine
racial/ethnic disparities in COVID-19 vaccination uptake by rurality of
residence. Methods: The study used national data derived from
the Understanding America Study – a national probability sample of US
adults – who completed online COVID-19 surveys between December 2020
and January 2023. Variations in vaccination uptake by race/ethnicity
(non-Hispanic White, non-Hispanic Black, Hispanic, other race) and
rurality of residence (urban, suburban, rural) were examined using a
multivariable logistic model with interactions of race/ethnicity and
rurality of residence. Analyses incorporated survey weights.
Findings: As of January 15, 2023, 76.5% (6,133 of 7,540
adults) had received at least one COVID-19 vaccination, with substantial
variations in vaccination uptake rates by rurality of residence and
race/ethnicity. In rural areas, vaccination uptake among non-Hispanic
Black individuals was higher (average predicted probability:
62.3% [95% Confidence Interval [CI] = 58.16, 66.35]) than
among non-Hispanic White individuals (86.5% [95% CI = 74.91,
98.01] p = 0.001). However, in urban areas, vaccination uptake was
similar for both groups. In urban areas, Hispanic individuals were
more likely to take up vaccination (86.6%, [95% CI = 82.78,
90.58]) than their non-Hispanic White counterparts (urban: 82.3%,
[95% CI = 79.98, 84.70] p = 0.016). Rural Hispanic and
non-Hispanic-White vaccination uptake rates were not significantly
different. Conclusions: Racial/ethnic disparities in COVID-19
vaccination uptake differed by rurality of residence. Identifying the
reasons underlying differential rates of COVID-19 vaccination uptake is
imperative for the development of effective strategies to broadly
improve vaccination uptake in the event of future pandemics.