JMIR Publications

ABSTRACT

Background:

Vaccination plays an important role in preventing Corona Virus Disease 2019 (COVID-19) infection and reducing the severity of the disease. However, the influencing factors of COVID-19 vaccination are complex and partially uncovered. There were differences in vaccination rates between urban and rural areas, not only for COVID-19, but also for other vaccines.

Objective:

To evaluate the disparities in the rate of fourth COVID-19 (second booster) vaccination between urban and rural areas in China.

Methods:

The cross-sectional study utilized a stratified random sampling approach to select representative samples from 11 communities and 10 villages in eastern (Changzhou), central (Zhengzhou), western (Xining) and northeast (Mudanjiang) in Chinese Mainland from February 1 to February 18, 2023. The vaccination of the participants was evaluated based on self-reported information provided. Binary logistic regression models were performed to explore influencing factors of vaccination among urban and rural participants, respectively. Urban-rural disparities in vaccination rate was assessed using Propensity Score Matching (PSM).

Results:

A total of 5780 participants (53.04% females) were included. The vaccination rate was 12.18% (95%CI: 11.34–13.02) in total sample, with 13.76% (95%CI: 12.40–15.12) in rural participants and 10.99% (95%CI: 9.93–12.06) in urban participants, respectively. For rural participants, self-report health condition, self-efficacy, educational level, vaccine knowledge, susceptibility, benefits, and trust in the healthcare system were independent factors associated with vaccination (all P＜0.05). For urban participants, chronic condition, COVID-19 infection, subjective community level, vaccine knowledge, self-efficacy, and trust in the healthcare system were independent factors associated with vaccination (all P＜0.05). PSM analysis uncovered a 3.42% difference in vaccination between urban and rural participants.

Conclusions:

The fourth COVID-19 (second booster) vaccination coverage rate among the Chinese population was extremely low and was significantly lower than the previous vaccine coverage rate. Given COVID-19 infection is still prevalent at a low level currently, efforts should be focused on enhancing self-efficacy to expand vaccine coverage rate among the Chinese. For rural residents, building the confidence of vaccination benefits and improving the health status of the population should be prioritized. In urban areas, a larger proportion of people infected with COVID-19 and chronic patients should be vaccinated.