COVID-19 Vaccine Receipt in Veterans Higher Among Racial/Ethnic Minorities

By Linda Carroll

October 28, 2021

NEW YORK (Reuters Health) - Most racial and ethnic minorities receiving treatment at the Veterans Health Administration (VA) had higher rates of COVID-19 vaccination than whites, in contrast to the general population, a new study shows.

An analysis of data from more than 3.4 million VA outpatient users revealed that Black patients had 28% higher odds than whites of getting vaccinated against the virus (95% confidence interval, 17% to 40%). Similarly, compared with white patients, Hispanic and Asian patients were also significantly more likely to get vaccinated against SARS-CoV-2 (odds ratio, 1.15 and 1.21, respectively), researchers report in the American Journal of Preventive Medicine.

"Our findings may reflect reduced logistical barriers in the VA healthcare system compared to private healthcare," said senior author Dr. Donna Washington of the VA Greater Los Angeles Department of Medicine.

"To maximize COVID-19 vaccine access, VA applied strategies including offering both technology-based and non-technology-based appointment scheduling, walk-ins, and calling eligible Veterans to schedule vaccinations," Dr. Washington, also a professor of medicine at the University of California, Los Angeles, told Reuters Health by email. "Based on evidence of vaccine hesitancy among racial/ethnic minority groups, VA used strategies such as listening sessions with diverse Veterans and staff, targeted electronic communications, and outreach activities to foster trust prior to and during the COVID-19 vaccine rollout."

The "VA's approach to patient-centered prevention may be applied to the general population," Dr. Washington said. "For example, other public health departments and other health systems could identify and address logistical barriers to vaccination receipt, and could tailor outreach material to address vaccination myths that have been identified in diverse populations."

To take a closer look at rates of vaccination among various racial and ethnic groups at the VA, the researchers turned to administrative data for veterans aged 65 and older who were received care through the VA between 2018 and 2020. From the administrative data, the researchers were able to glean patient demographics.

Most of the veterans who used VA services during the study period were male (97%) and 75% were white, 11% Black, 4% Hispanic, 0.7% Asian, 0.6% American Indian/Alaska Natives, 0.6% Native Hawaiian or other Pacific Islander and 0.6% multi-race.

Overall, 24% of the patients received at least one COVID-19 vaccine dose through the VA as of February 23, 2021, including 29% Black, 27% Hispanic, 27% Asian and 24% white patients. AI/AN patients were less likely than whites to receive the shot, but the researchers suspect that may be because those patients also had access through Indian Health Services.

The VA employed several strategies to maximize vaccine access, the researchers note. The VA offered both technology-based and non-technological appointment scheduling, walk-ins, and calling eligible veterans to schedule vaccinations. To combat hesitancy, the VA employed strategies such as listening sessions with diverse veterans and staff, targeted electronic communications, and out-reach activities, such as vaccination events, to foster trust prior to and during the vaccine roll-out.

"This study is important because it focuses on the largest health care system in the U.S. - The Veterans Affairs health care system," said Dr. Albert Wu, an internist and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

"The VA system is government-run, single-payer, classic example of a socialized model," Dr. Wu, who was not involved in the research, told Reuters Health by email. "This study suggests that at least in some cases, it can be more effective than care delivered in the rest of the country."

"The unexpected finding was that COVID-19 vaccine was higher among most racial and ethnic minority groups than whites," Dr. Wu said. "This suggests that the VA system may have fewer barriers to access than non-VA care. It also suggests that universal health coverage has the potential to support care that is more equitable than the current U.S. insurance system."

SOURCE: https://bit.ly/3BncRCg American Journal of Preventive Medicine, online October 21, 2021.

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