JMIR Publications

ABSTRACT

Background:

Coronavirus disease 2019 (COVID-19) had been a stronger hit in Deep South compared with other developed regions in the United States, and vaccination remains a top priority for all eligible individuals. However, there are limited data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age group, which is of critical importance for future vaccine planning. Racial/ethnic disparities were found in the COVID-19 vaccination, but the vast majority of evidence was generated from studies at the individual level. There is an urgent need for evidence at the population level to reveal and evaluate the booster coverage in racial/ethnic minority communities, which could identify vulnerable communities and inform future healthcare policymaking and resource allocation.

Objective:

We evaluated county-level COVID-19 booster coverage by age group in the Deep South and examined its relationship with residential segregation.

Methods:

We conducted an ecological study at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of five Deep South states from December 15, 2021 to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster coverage by age group (e.g., 12 to 17 years old, 18 to 64 years old, and at least 65 years old) by the end of the study period. We examined the longitudinal relationships between residential segregation, the interaction of time and residential segregation, and COVID-19 booster coverage using Poisson mixed model.

Results:

As of October 19, 2022, among the 418 counties, the median percentage of booster coverage was 40% (interquartile range [IQR]: 37.8—43.0%). Compared with elders (i.e., at least 65 years old, 63.1% [IQR: 59.5—66.5%]), youth (i.e., 12 to 17 years old, 14.1% [IQR: 11.3—17.4%]) and adults (i.e., 18 to 64 years old, 33.4% [IQR: 30.5—36.5%]) had lower percentages of booster uptake. There was geospatial heterogeneity in the COVID-19 booster coverage. Results of the Poisson mixed model found that as time increased, higher segregated counties had lower percentages of booster coverage. Such relationships were consistent across the age groups.

Conclusions:

The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccine planning should focus on youth and adults. Healthcare facilities and resources are needed in racial/ethnic minority communities.