Factors associated with COVID-19 vaccine receipt at two integrated healthcare systems in New York City: a cross-sectional study of healthcare workers

  1. Kristin Oliver
  2. Anant Raut
  3. Stanley Pierre
  4. Leopolda Silvera
  5. Alexander Boulos
  6. Alyssa Gale
  7. Aaron Baum
  8. Ashley Chory
  9. Nichola J Davis
  10. David D'Souza
  11. Amy Freeman
  12. Crispin Goytia
  13. Andrea Hamilton
  14. Carol Horowitz
  15. Nadia Islam
  16. Jessica Jeavons
  17. Janine Knudsen
  18. Sheng Li
  19. Jenna Lupi
  20. Roxanne Martin
  21. Sheela Maru
  22. Ismail Nabeel
  23. Dina Pimenova
  24. Anya Romanoff
  25. Sonya Rusanov
  26. Nina R Schwalbe
  27. Nita Vangeepuram
  28. Rachel Vreeman
  29. Joseph Masci
  30. Duncan Maru

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Abstract

To examine the factors associated with COVID-19 vaccine receipt among healthcare workers and the role of vaccine confidence in decisions to vaccinate, and to better understand concerns related to COVID-19 vaccination.

Design

Cross-sectional anonymous survey among front-line, support service and administrative healthcare workers.

Setting

Two large integrated healthcare systems (one private and one public) in New York City during the initial roll-out of the COVID-19 vaccine.

Participants

1933 healthcare workers, including nurses, physicians, allied health professionals, environmental services staff, researchers and administrative staff.

Primary outcome measures

The primary outcome was COVID-19 vaccine receipt during the initial roll-out of the vaccine among healthcare workers.

Results

Among 1933 healthcare workers who had been offered the vaccine, 81% had received the vaccine at the time of the survey. Receipt was lower among black (58%; OR: 0.14, 95% CI 0.1 to 0.2) compared with white (91%) healthcare workers, and higher among non-Hispanic (84%) compared with Hispanic (69%; OR: 2.37, 95% CI 1.8 to 3.1) healthcare workers. Among healthcare workers with concerns about COVID-19 vaccine safety, 65% received the vaccine. Among healthcare workers who agreed with the statement that the vaccine is important to protect family members, 86% were vaccinated. Of those who disagreed, 25% received the vaccine (p<0.001). In a multivariable analysis, concern about being experimented on (OR: 0.44, 95% CI 0.31 to 0.6), concern about COVID-19 vaccine safety (OR: 0.39, 95% CI 0.28 to 0.55), lack of influenza vaccine receipt (OR: 0.28, 95% CI 0.18 to 0.44), disagreeing that COVID-19 vaccination is important to protect others (OR: 0.37, 95% CI 0.27 to 0.52) and black race (OR: 0.38, 95% CI 0.24 to 0.59) were independently associated with COVID-19 vaccine non-receipt. Over 70% of all healthcare workers responded that they had been approached for vaccine advice multiple times by family, community members and patients.

Conclusions

Our data demonstrated high overall receipt among healthcare workers. Even among healthcare workers with concerns about COVID-19 vaccine safety, side effects or being experimented on, over 50% received the vaccine. Attitudes around the importance of COVID-19 vaccination to protect others played a large role in healthcare workers’ decisions to vaccinate. We observed striking inequities in COVID-19 vaccine receipt, particularly affecting black and Hispanic workers. Further research is urgently needed to address issues related to vaccine equity and uptake in the context of systemic racism and barriers to care. This is particularly important given the influence healthcare workers have in vaccine decision-making conversations in their communities.

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  1. Version published to 10.1136/bmjopen-2021-053641
  2. ScreenIT

    SciScore for 10.1101/2021.03.24.21253489: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Ethical approval: Our study was determined to be exempt by the Icahn School of Medicine at Mount Sinai Institutional Review Board (study#20-01964).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    The survey was available electronically via REDCap and by paper upon request.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    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:
    Limitations: The high rate of COVID-19 vaccine acceptance in our population may be the result of response bias, where healthcare workers with favorable vaccine attitudes were more likely to complete the survey. Our study may have some limits in generalizability given the setting in New York City and a substantial representation from an academic health system. Additionally, Black and Hispanic respondents were underrepresented in our survey, comprising 10% and 16% of our survey population respectively, whereas approximately 20% of the healthcare workers in our systems’ hospitals identify as Black and 18% identify as Hispanic. We chose explicitly to use receipt as the primary outcome, rather than intent. As such, participants who indicated they “planned” to receive the vaccine were categorized for the primary outcome along with those who stated that they did not plan to. We did review the differences between these two groups and assessed differences over time (see Supplementary Figure 5). Those who stated an intent may have had perceptual or belief reasons for delaying, as several participants expressed in their free text responses. Additionally, while the COVID-19 vaccines were made available to employees at the time of the survey, many may have had access issues, which our survey was not designed to assess. The 11% of respondents in our survey who reported they planned to get the vaccine but had not scheduled or gone for their vaccine yet may have experienced access issues. We...

    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.
    • Thank you for including a protocol registration statement.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.03.24.21253489v1 on medRxiv