COVID-19 Vaccination Coverage Among Insured Persons Aged ≥16 Years, by Race/Ethnicity and Other Selected Characteristics

Eight Integrated Health Care Organizations, United States, December 14, 2020-May 15, 2021

Cassandra Pingali, MPH, MS; Mehreen Meghani, MPH; Hilda Razzaghi, PhD; Mark J. Lamias; Eric Weintraub, MPH; Tat'Yana A. Kenigsberg, MPH; Nicola P. Klein, MD, PhD; Ned Lewis, MPH; Bruce Fireman, MS; Ousseny Zerbo, PhD; Joan Bartlett, MPH, MPP; Kristin Goddard, MPH; James Donahue, DVM, PhD; Kayla Hanson, MPH; Allison Naleway, PhD; Elyse O. Kharbanda, MD; W. Katherine Yih, PhD; Jennifer Clark Nelson, PhD; Bruno J. Lewin, MD; Joshua T.B. Williams, MD; Jason M. Glanz, PhD; James A. Singleton, PhD; Suchita A. Patel, DO

Disclosures

Morbidity and Mortality Weekly Report. 2021;70(28):985-990. 

In This Article

Abstract and Introduction

Introduction

COVID-19 vaccination is critical to ending the COVID-19 pandemic. Members of minority racial and ethnic groups have experienced disproportionate COVID-19–associated morbidity and mortality;[1] however, COVID-19 vaccination coverage is lower in these groups.[2] CDC used data from CDC's Vaccine Safety Datalink (VSD)* to assess disparities in vaccination coverage among persons aged ≥16 years by race and ethnicity during December 14, 2020–May 15, 2021. Measures of coverage included receipt of ≥1 COVID-19 vaccine dose (i.e., receipt of the first dose of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of the Janssen COVID-19 vaccine [Johnson & Johnson]) and full vaccination (receipt of 2 doses of the Pfizer-BioNTech or Moderna COVID-19 vaccines or 1 dose of Janssen COVID-19 vaccine). Among 9.6 million persons aged ≥16 years enrolled in VSD during December 14, 2020–May 15, 2021, ≥1-dose coverage was 48.3%, and 38.3% were fully vaccinated. As of May 15, 2021, coverage with ≥1 dose was lower among non-Hispanic Black (Black) and Hispanic persons (40.7% and 41.1%, respectively) than it was among non-Hispanic White (White) persons (54.6%). Coverage was highest among non-Hispanic Asian (Asian) persons (57.4%). Coverage with ≥1 dose was higher among persons with certain medical conditions that place them at higher risk for severe COVID-19 (high-risk conditions) (63.8%) than it was among persons without such conditions (41.5%) and was higher among persons who had not had COVID-19 (48.8%) than it was among those who had (42.4%). Persons aged 18–24 years had the lowest ≥1-dose coverage (28.7%) among all age groups. Continued monitoring of vaccination coverage and efforts to improve equity in coverage are critical, especially among populations disproportionately affected by COVID-19.

VSD is a collaboration between CDC's Immunization Safety Office and eight integrated health care organizations in six U.S. states. VSD captures information on COVID-19 vaccine doses administered, regardless of where they are received, based on an automated search within the organizations' facilities (outpatient and inpatient records) and external systems (e.g., health insurance claims and state or local immunization information systems). VSD data on administered COVID-19 vaccine doses were captured from December 14, 2020, when the Pfizer-BioNTech vaccine received Emergency Use Authorization in the United States,§ through May 15, 2021. Data were reported to CDC weekly beginning January 9, 2021. The analysis excluded 561 persons aged 16–17 years who received Janssen or Moderna vaccine, because persons in this age group were eligible for the Pfizer-BioNTech vaccine only during the study period.

Coverage with ≥1 COVID-19 vaccine dose was defined as the proportion of persons who received a first dose of Pfizer-BioNTech or Moderna COVID-19 vaccine, or 1 dose of Janssen COVID-19 vaccine. Full vaccination was defined as receipt of 2 doses of Pfizer-BioNTech or Moderna COVID-19 vaccine or 1 dose of Janssen COVID-19 vaccine. Coverage was estimated for persons who received ≥1 dose and persons who were fully vaccinated by racial or ethnic minority groups, age, sex, presence of a high-risk condition, and COVID-19 illness history. Data on race and ethnicity were available for 88.3% of the VSD population; data on age, sex, high-risk condition, and history of COVID-19 illness were 100% complete. COVID-19 illness history was defined using an internal International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code indicating that the person had COVID-19** or a positive laboratory test result before vaccination. All analyses were performed using SAS (version 9.4; SAS Institute), and data were a census of all persons in the population (i.e., VSD); therefore, statistical tests were not performed to assess differences between groups. Absolute differences in coverage were calculated using White persons as the reference group (coverage among racial/ethnic group of interest minus coverage among White persons). This activity was reviewed by CDC and VSD sites and was conducted consistent with applicable federal law and CDC policy.††

During December 14, 2020–May 15, 2021, 9.6 million persons aged ≥16 years were continuously enrolled in VSD. The VSD population was 41.2% White, 6.5% Black, 24.2% Hispanic, 12.1% Asian, 3.3% non-Hispanic multiple or other race, 0.6% non-Hispanic Native Hawaiian or Other Pacific Islander, 0.3% non-Hispanic American Indian or Alaskan Native (AI/AN); race or ethnicity were unknown for 11.7%. By May 15, 2021, 48.3% of persons aged ≥16 years had received ≥1 COVID-19 vaccine dose, and 38.3% were fully vaccinated.

Coverage with ≥1 COVID-19 vaccine dose was highest among Asian (57.4%) and White persons (54.6%) and lowest among Hispanic (41.1%) and Black persons (40.7%) (Table). Similar racial/ethnic variations were observed among fully vaccinated persons. Coverage with ≥1 dose increased weekly for all racial/ethnic minority groups during December 14, 2020–May 15, 2021 (Figure 1). Coverage as of Feb 13, 2021 was 8.2% for Hispanic persons, 9.3% for Black persons and 15.5% for Asian persons, while coverage as of May 15, 2021 was 41.1%, 40.7%, and 57.4% respectively. The absolute difference in coverage between White persons and all minority racial/ethnic groups generally increased over time, except Asian persons (Figure 1). The absolute percentage point difference in coverage between Black and White persons and between Hispanic and White persons increased over the study period from 6% (Black persons) and 8% (Hispanic persons) as of February 13, 2021 to 14% for both Black and Hispanic persons as of May 15, 2021.

Figure 1.

COVID-19 vaccination coverage* and difference in vaccination coverage among persons aged ≥16 years, by race/ethnicity§ and week — Vaccine Safety Datalink, United States, December 14, 2020–May 15, 2021
Abbreviations: AI/AN = American Indian or Alaska Native; NH = non-Hispanic; NH/PI = Native Hawaiian or Pacific Islander; ppt = percentage point.
*At least 1 dose of COVID-19 vaccine is defined either as the first of 2 doses of Pfizer-BioNTech or Moderna vaccines, or a single dose of Janssen (Johnson & Johnson) vaccine during December 14, 2020–May 15, 2021.
Ppt difference in coverage from that in the White population (race/ethnicity coverage – NH, White coverage).
§Hispanic persons could be of any race. Black, White, Asian, AI/AN, NH/PI, and multiracial persons were non-Hispanic.

Coverage with ≥1 dose was highest among persons aged ≥75 years (76.5%) and decreased with age; coverage was 28.7% among persons aged 18–24 years and 29.6% among those aged 16–17 years. Coverage with ≥1 dose was higher among females (50.8%) than among males (45.5%) (Table). Coverage among women was higher than that among men stratified by age, except among those aged ≥75 years (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/107670). Coverage with ≥1 dose was higher among persons with high-risk conditions (63.8%) than among persons without these conditions (41.5%), and among persons with no history of COVID-19 (48.8%) than among those with a history of COVID-19 (42.4%) (Table). Full vaccination coverage patterns were similar to ≥1-dose coverage by age, sex, high-risk conditions status, and history of COVID-19.

Asian persons had the highest coverage overall and among those with a high-risk condition (68.6%) or a history of COVID-19 illness (56.4%) (Figure 2). Among persons with and without high-risk conditions, Black persons had the lowest ≥1-dose coverage (55.6% and 30.4%, respectively).

Figure 2.

Coverage with ≥1 dose of COVID-19 vaccine* among persons aged ≥16 years, by race/ethnicity and having a high-risk condition for severe COVID-19 or history of COVID-19§,¶ — Vaccine Safety Datalink, United States, December 14, 2020–May 15, 2021
Abbreviations: AI/AN = American Indian or Alaska Native; ICD-10 = International Classification of Diseases, Tenth Revision; NH/PI = Native Hawaiian or Pacific Islander.
*At least 1 dose of COVID-19 vaccine is defined either as the first of 2 doses of Pfizer-BioNTech or Moderna vaccines, or 1 dose of Janssen (Johnson & Johnson) vaccine during December 14, 2020–May 15, 2021.
Hispanic persons could be of any race. Black, White, Asian, AI/AN, NH/PI, and multiracial persons were non-Hispanic.
§All patients' records from the outpatient and inpatient settings are screened (automated records review and chart review) for underlying medical conditions that increase the risk of severe COVID-19 using ICD-10 codes.
Medical diagnostic codes were used to identify persons with a history of COVID-19 illness. Patient records were also screened for positive lab tests for COVID-19 illness before vaccination. The new ICD-10-Clinical Modification code went into effect on April 1, 2020. https://www.cdc.gov/nchs/data/icd/Announcement-New-ICDcode-for-coronavirus-3-18-2020.pdf

Among persons aged ≥75 years, Black and Hispanic persons had similar ≥1-dose coverage to that of White and Asian persons; among younger age groups, ≥1-dose coverage among Black and Hispanic persons was lower than that among White and Asian persons (Supplementary Table 2, https://stacks.cdc.gov/view/cdc/107671). Variations in coverage were also observed by age (Supplementary Table 1, https://stacks.cdc.gov/view/cdc/107670) and vaccine type (Supplementary Table 3, https://stacks.cdc.gov/view/cdc/107672).

*https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html, https://www.cdc.gov/vaccinesafety/ensuringsafety/monitoring/vsd/
The eight participating VSD health care organizations are located in California (two sites), Colorado (two sites), Minnesota, Oregon, Wisconsin, and Washington, and monitor vaccine safety among 11.6 million insured persons. One additional site (in Massachusetts) provides subject matter expertise on vaccine safety research and surveillance.
§As of May 2021, all adults aged ≥18 years can receive any of the three COVID-19 vaccines available in the United States via Emergency Use Authorization from the Food and Drug Administration, including Pfizer-BioNTech, Moderna, and Janssen (Johnson & Johnson); persons aged 16–17 years are eligible to receive the Pfizer-BioNTech COVID-19 vaccine.
All patients' records from outpatient and inpatient settings are screened by automated records review and chart review for underlying medical conditions that increase the risk for severe COVID-19, using ICD-10 codes. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
**A combination of ICD-10 COVID-19 codes and internal medical diagnostics codes were used to identify persons with a history of COVID-19. Patient records were also screened for positive laboratory test results indicating COVID-19 before receipt of vaccination. The new ICD-10-CM code came into effect April 1, 2020. https://www.cdc.gov/nchs/data/icd/Announcement-New-ICD-code-for-coronavirus-3-18-2020.pdf
††45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.

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