Racial discrimination, low trust in the health system and COVID-19 vaccine uptake: a longitudinal observational study of 633 UK adults from ethnic minority groups
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Abstract
To examine whether racial/ethnic discrimination predicts future COVID-19 vaccine refusal, and whether this association is explained by trust in government and the health system.
Design
Longitudinal observational study of racial/ethnic discrimination occurring since the start of the first lockdown (measured in July 2020) and later COVID-19 vaccine status.
Setting
UK (England, Scotland, Wales and Northern Ireland).
Participants
A total of 633 adults belonging to ethnic minority groups who took part in the UCL COVID-19 Social Study.
Main outcome measures
COVID-19 vaccine refusal (vs. accepted/waiting/had at least one dose) between 23 December 2020 and 14 June 2021.
Results
Nearly 1 in 10 (6.69%) who had refused a COVID-19 vaccine had experienced racial/ethnic discrimination in a medical setting since the start of the pandemic and had experienced twice as many incidents of racial/ethnic discrimination than those who had accepted the vaccine. Structural equation modelling results indicated a nearly four fold (odds ratio = 3.91, 95% confidence interval = 1.40 to 10.92) total effect of racial/ethnic discrimination on refusing the vaccine which was mediated by low trust in the health system to handle the pandemic (odds ratio = 2.49, 95% confidence interval = 1.12 to 5.39). Analyses adjusted for a range of demographic and COVID-19 related factors.
Conclusions
Findings underscore the importance of addressing racial/ethnic discrimination and the role the National Health Service in regaining trust from ethnic minority groups to increase COVID-19 vaccine uptake among ethnic minority adults.
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SciScore for 10.1101/2021.08.26.21262655: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethics statement: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.
Consent: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.Sex as a biological variable Covariates: Demographic variables were measured at baseline interview: gender (male, female), education level (university degree (bachelors or higher), A-levels/equivalent or vocational, up to GCSE/O levels), and age (18-29, 30-44, 45-59, 60+). Randomization Sampling is not random and … SciScore for 10.1101/2021.08.26.21262655: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Ethics statement: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.
Consent: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.Sex as a biological variable Covariates: Demographic variables were measured at baseline interview: gender (male, female), education level (university degree (bachelors or higher), A-levels/equivalent or vocational, up to GCSE/O levels), and age (18-29, 30-44, 45-59, 60+). Randomization Sampling is not random and therefore is not representative of the UK population, but the study does contain a heterogeneous sample. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Further, due limitations in question phrasing (i.e., ‘White-British, Irish, other’), we were unable to examine associations between study variables and vaccine refusal in White subgroups, some of whom have also had lower COVID-19 vaccine uptake.1 The most common ethnic group in those who had refused the vaccine was the ‘other ethnic group’. Similarly, nearly one in ten (7.4%) in the total sample said they had experienced some ‘other’ form of discrimination related to their race or ethnicity. We also did not collect data on the frequency or severity of each type of racial/ethnic discrimination experience. Future research should therefore provide participants with opportunities to write in their identified ethnic group and specify other types of racial discrimination experienced. Additionally, future studies should collect information on how often experiences of racial/ethnic discrimination occur. The adverse effects of racial/ethnic discrimination on health and health outcomes in marginalised ethnic groups are well-established in the literature.7 Structural racism in particular ethnic residential segregation, which is increasing in the UK and Europe,33,34 create conditions that amplify mistrust in government and the health system.7,33 Our study builds upon recent reports that racial discrimination increases covid-19 vaccine hesitancy10 by demonstrating that a nearly four-fold effect of racial discrimination on vaccine refusal is mediated by low trust in the health system. Thes...
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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