Sociodemographic inequality in COVID-19 vaccination coverage among elderly adults in England: a national linked data study
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Abstract
To examine inequalities in COVID-19 vaccination rates among elderly adults in England.
Design
Cohort study.
Setting
People living in private households and communal establishments in England.
Participants
6 655 672 adults aged ≥70 years (mean 78.8 years, 55.2% women) who were alive on 15 March 2021.
Main outcome measures
Having received the first dose of a vaccine against COVID-19 by 15 March 2021. We calculated vaccination rates and estimated unadjusted and adjusted ORs using logistic regression models.
Results
By 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 73.8% had received a vaccine, with adjusted odds of not being vaccinated at 5.01 (95% CI 4.86 to 5.16) and 4.85 (4.75 to 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 socioeconomic position (proxied by living in a rented home), being disabled and living either alone or in a multigenerational household were also associated with higher odds of not having received the vaccine.
Conclusion
Research is now urgently needed to understand why disparities exist in these groups and how they can best be addressed through public health policy and community engagement.
Article activity feed
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SciScore for 10.1101/2021.05.13.21257146: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitation: The primary study strength is using nationwide linked population-level data from clinical records and the 2011 Census. Unlike studies based solely on electronic health records, we examined a wide range of socio-demographic …
SciScore for 10.1101/2021.05.13.21257146: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitation: The primary study strength is using nationwide linked population-level data from clinical records and the 2011 Census. Unlike studies based solely on electronic health records, we examined a wide range of socio-demographic characteristics. Unlike surveys, we can precisely estimate vaccination rates and odds ratios for small groups. The main limitation is that most 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 (adults aged ≥ 70), such as household tenure. However, for the characteristics likely to change over time, such as disability status, the time difference may introduce some bias into the estimates, although this would be expected to dilute differences, since we are most likely missing some long-term health conditions. Care home residency and area deprivation were derived from the 2019 Patient register and are therefore not subject to the same biases. Another limitation is that because the Public Health Data Asset was 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 to the ONS PHDA.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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