ABSTRACT
Purpose: KTRs comprise a high-risk group for COVID-19 infection due to comorbidities and immunosuppression. Studying how vaccination hesitancy in inner-city KTRs has changed since the onset of the pandemic and their attitudes towards the vaccine in general is integral in the advancement of a successful vaccination effort. Method(s): A random sample of 30 KTRs in 2020 and 9 recipients in 2021 were surveyed about attitudes towards and history of vaccines. Respondents who received both doses, one dose, or were planning on doing so were recorded as VACYES while those who were unsure or refused were recorded as VACNO. Respondents were also asked their top reasons for receiving or not receiving the vaccine. Result(s): Mean age in 2020 was 57.8 +/- 10.6 yrs, time since transplant was 8.9 +/- 6.6 yrs with18 (60%) men, 20 (71.4%) identified as black. Mean age in 2021 was 50.9 yrs +/- 9.1 yrs, time since transplant 6.8 yrs +/- 8.6 yrs with 3 (33.3%) men. There was no significant difference between the two samples for time since transplant, age sex, race, or percent with diabetes or hypertension. Prior to vaccine availability in 2020 only 36.7% indicated they would accept a COVID-19 vaccination. By 2021, the number had increased to 66.7% who had either received or were planning on receiving the vaccine (p < 0.001). Among the pts who were VACNO in 2020, the most commonly cited reason was concern about vaccine safety (53%). Between VACYES and VACNO patients in 2021, there were no statistically significant differences with respect to time since transplant, sex, race, education or comorbidities but VACYES pts were older (58.8+/-2.3 vs 47.0+/-8.7 yrs, p=0.021). Among VACYES, the most commonly cited reason for vaccine acceptance was that it was recommended for people with underlying conditions (80%). 100% of VACYES felt confident about the safety and efficacy of the COVID-19 vaccines compared to 33% of VACNO. 100% of VACYES believed it is okay for the government to mandate vaccinations compared to 0% of VACNO. 100% of VACNO pts felt COVID-19 was preventable vs 100% of VACYES who stated they did not know (p<0.05). 86% of both VACYES and VACNO believe that the hospital system could take care of them if sick with COVID-19. Conclusion(s): In our population: 1. Vaccine hesitancy has decreased in our inner-city KTR sample compared to the previous year, but almost 40% remain unvaccinated. 2. The most important reason cited for receiving the vaccine was because it was recommended for patients with underlying conditions. 3. Pts who received the vaccine were older, feel more confident about its safety and efficacy, and believe a government mandate is ok. 4. Pts who refused were more likely to believe that COVID-19 is preventable. 5. Regardless of vaccination status, pts believed that the healthcare system could help them if sick with COVID-19. 6. Understanding the motivation for acceptance and reasons for refusal in underserved KTR populations will be important in increasing vaccine acceptance.
ABSTRACT
We investigated how food purchasing behavior changed in a cohort of inner-city dialysis patients during the COVID-19 pandemic. 33 dialysis patients were surveyed face-to-face about use of grocery stores, restaurants, take-out, and use of SNAP or other benefits over the past year. The survey also assessed patient attitudes and fear relating to COVID-19. Mean age was 57.1±17.9 yrs, 20 (61%) men, 91% identified as Black. 9/20 pts (27%) reported yearly income under $20,000 with 70% less than $40,000. The number of pts using SNAP, WIC, or Greenmarket Bucks to buy groceries increased from 21% before the pandemic to 33% after (p=0.019). Age correlated negatively with feeling safe eating at a restaurant indoors (r=-0.47, p=0.008), or outdoors (r=-0.58, p=<0.001) and increased use of take-out since the start of the pandemic (r=-0.39, p=0.032). There was a significant difference in pts who purchased breakfast (45.9±4.0 vs 65.3±3.6, p<.001), lunch (49.7±4.1 vs 65.3±4.0, p=.006), and dinner compared to those who didn’t (48.5±4.9 vs 60.9±3.9, p=0.031). There was a positive correlation between income and the frequency that pts purchased breakfast (r=0.45, p=0.048) and lunch (r=0.45, p=0.046). There was a negative correlation between age and the statement “I wish I could cook more meals at home” (r=-0.497, p=0.004) and a positive correlation with income (r=0.06, p=0.006). There was no association between age and income. Only 6% (2) pts were employed and both were <60 yrs old. In our population of inner-city dialysis pts: 1. Use of food assistance programs increased since the start of the pandemic. 2. Older pts felt less safe eating at restaurants regardless of whether it was indoors or outdoors and were more likely to make meals at home. 4. Younger patients were more likely to eat take-out food and reported they wished they could cook more meals at home. 5. Increased use of food programs and association of younger age or lower income with eating out suggests that careful nutritional guidance should be emphasized as dietary habits have changed since the pandemic and eating out has been associated with worse adherence to sodium and other restrictions in pts on dialysis.
ABSTRACT
Understanding factors that impact vaccine hesitancy in underserved populations is of paramount importance. A random sample of 31 dialysis pts were surveyed regarding COVID-19 vaccination status, attitudes towards vaccines and perception of healthcare/government authority. Respondents who received both doses, one dose, or were planning on doing so were recorded as VACYES while those who were unsure or refused were recorded as VACNO. Mean age was 56.1 ± 17.9 yrs, time on dialysis 6.2 ± 7.2 yrs with 18 (58%) women, 13 (42%) men, 28 (90%) identified as black. 84% had received the vaccine. There were no statistically significant differences between VACYES and VACNO for age, time on dialysis, sex, race, education, insurance status, and presence of diabetes. VACYES were more likely to agree with trust in the information about the vaccine (r = 0.57, p < 0.001), felt confident about the safety and efficacy (r = 0.75, p < 0.001), and trusted government guidelines regarding COVID-19 (r = 0.73, p < 0.001). Pts who believed it was okay for the government to mandate vaccinations (r = 0.52, p = 0.003), mandate COVID-19 vaccinations (r = 0.58, p = 0.001), and believe we should all follow government guidelines to protect public health (r = 0.41, p = 0.02) were also more likely to be VACYES. They also believed that hospitals could care for them if sick with COVID-19 (r = 0.62, p < 0.001), felt they had an active partnership with their provider (r = 0.42, p = 0.02) and felt having regular contact with their physician was the best way to avoid illness (r = 0.38, p = 0.04). VACNO pts were more likely to say they had less contact with medical professionals regarding their dialysis restrictions (r = - 0.63, p < 0.001) and felt their provider did not listen to them (r = - 0.38, p = 0.04). In our population of inner-city dialysis patients: 1. The majority are vaccinated against COVID-19. 2. Pts were more likely to have received the vaccine if they had trust in the government regarding COVID-19 and in the healthcare system in general. 3. Pts who reported more shared decision making were more likely to receive the vaccine and this should be emphasized in education efforts for vaccine acceptance in our vulnerable population.