Receipt of COVID-19 Vaccine is Higher among Racial/Ethnic Minorities than Whites within VA Healthcare System

BACKGROUND:
Equitable vaccination access is a key concern for the US COVID-19 vaccine rollout, with Blacks and Hispanics having lower vaccination rates than Whites. VA began administering COVID-19 vaccinations shortly after the US rollout began, allowing for an examination of vaccination rates among racial/ethnic minorities in an integrated healthcare system with few barriers to access. Using VA data, investigators identified VA outpatient users aged 65 or older (n=3,474,874) and assessed the receipt of COVID-19 vaccination between December 14, 2020 and February 23, 2021 (a time frame prior to widespread vaccine availability to groups under age 65). Patient demographics and medical comorbidities also were examined. To address any potential correlation between influenza vaccination and COVID-19 vaccination uptake, influenza vaccination was included as a covariate. In addition, Contract Health Service Delivery Area (CHSDA) county designation, which indicates residence in/adjacent to federally reserved tribal lands, was determined to represent potential access to Indian Health Service (IHS) care for American Indian and Alaska Native (AI/AN) Veteran populations.

FINDINGS:

• In contrast to disparities reported in the general population, COVID-19 vaccine receipt in the VA healthcare system was higher among most racial/ethnic minority groups than in Whites, suggesting reduced vaccination barriers compared with non-VA care.
• Overall, 24% of the cohort received at least one vaccine dose as of 2/23/21. Black (29%), Hispanic (27%), and Asian (27%) Veterans were significantly more likely than White (24%) Veterans to receive a vaccination through VA, while AI/AN Veterans were less likely.
  • Only AI/ANs in CHSDA counties were less likely than Whites to be vaccinated.
• Influenza vaccination history was positively associated with COVID-19 vaccine uptake.

IMPLICATIONS:

• Addressing vaccination access barriers in non-VA settings can potentially reduce racial/ethnic disparities. Further, since AI/AN Veterans were less likely to obtain COVID-19 vaccinations through VA when close to a tribal area, IHS may provide a safety net that is effective at reaching this population despite disparities in other contexts.
• Prior influenza vaccine receipt is a strong predictor of COVID-19 vaccine receipt.

LIMITATIONS:

• While it is posited that lower vaccine use among AI/ANs could relate to IHS use, that was not assessed directly.

AUTHOR/FUNDING INFORMATION:
This study was funded by VA’s Office of Health Equity (OHE), HSR&D, and QUERI. Drs. Haderlein, Wong, Yuan, and Washington are part of HSR&D’s Center for the Study of Health Care Innovation, Implementation and Policy (CSHIIP). Drs. Jones and Moy lead OHE, and Dr. Washington leads the Health Equity QUERI Partnered Evaluation Center.

Haderlein T, Wong M, Jones K, Moy E, Yuan A, and Washington DL. Racial/Ethnic Variation in Veterans Health Administration COVID-19 Vaccine Uptake. American Journal of Preventive Medicine. October 21, 2021; online ahead of print.