Sociodemographic inequality in COVID-19 vaccination coverage amongst elderly adults in England: a national linked data study

ABSTRACT

ObjectiveTo examine inequalities in COVID-19 vaccination rates amongst elderly adults in England DesignCohort study SettingPeople living in private households and communal establishments in England Participants6,829,643 adults aged [≥] 70 years (mean 78.7 years, 55.2% female) who were alive on 15 March 2021. Main outcome measuresHaving received the first dose of a vaccine against COVID-19 by 15 March 2021. We calculated vaccination rates and estimated unadjusted and adjusted odds ratios using logistic regression models. ResultsBy 15 March 2021, 93.2% of people living in England aged 70 years and over had received at least one dose of a COVID-19 vaccine. While vaccination rates differed across all factors considered apart from sex, the greatest disparities were seen between ethnic and religious groups. The lowest rates were in people of Black African and Black Caribbean ethnic backgrounds, where only 67.2% and 73.9% had received a vaccine, with adjusted odds of not being vaccinated at 5.01 (95% CI 4.86 - 5.16) and 4.85 (4.75 - 4.96) times greater than the White British group. The proportion of individuals self-identifying as Muslim and Buddhist who had received a vaccine was 79.1% and 84.1%, respectively. Older age, greater area deprivation, less advantaged socio-economic position (proxied by living in a rented home), being disabled and living either alone or in a multi-generational household were also associated with higher odds of not having received the vaccine. ConclusionPeople disproportionately affected seem most hesitant to COVID-19 vaccinations. Policy Interventions to improve these disparities are urgently needed. Summary BoxO_ST_ABSWhat is already known on this subject?C_ST_ABSThe UK began an ambitious vaccination programme to combat the COVID-19 pandemic on 8th December 2020. Existing evidence suggests that COVID-19 vaccination rates differ by level of area deprivation, ethnicity and certain underlying health conditions, such as learning disability and mental health problems. What does this study add?Our study shows that first dose vaccination rates in adults aged 70 or over differed markedly by ethnic group and self-reported religious affiliation, even after adjusting for geography, socio-demographic factors and underlying health conditions. Our study also highlights differences in vaccination rates by deprivation, household composition, and disability status, factors disproportionately associated with SARS-CoV-2 infection. Public health policy and community engagement aimed at promoting vaccination uptake is these groups are urgently needed. Strengths and limitations of this studyO_LIUsing nationwide linked population-level data from clinical records and the 2011 Census, we examined a wide range of socio-demographic characteristics not available n electronic health records C_LIO_LIMost demographic and socio-economic characteristics are derived from the 2011 Census and therefore are 10 years old. However, we focus primarily on characteristics that are unlikely to change over time, such as ethnicity or religion, or likely to be stable for our population C_LIO_LIBecause the data are based on the 2011 Census, it excluded people living in England in 2011 but not taking part in the 2011 Census; respondents who could not be linked to the 2011-2013 NHS patients register; recent migrants. Consequently, we excluded 5.4% of vaccinated people who could not be linked C_LI