Social Determinants of Health (SDOH) barriers as predictors of intent to vaccinate for COVID-19 in a vulnerable population

ABSTRACT

Purpose: Determine the role of social determinants of health (SDOH), including socioeconomic status (SES) (education, income in predicting intent to vaccinate for COVID-19 among a diverse community-based population, over sampled for cancer survivors in Connecticut (CT). Background: Race, ethnicity, and the SDOH (e.g., food insecurity, housing instability, trouble paying utilities bills) have a known impact on COVID-19 incidence, morbidity, and mortality. Although the impact on cancer survivors is not as well understood, this population may also face disproportionately severe outcomes. To our knowledge, there are no published studies that address intention to vaccinate in community based populations that are predominantly African American/Black (AA) or Hispanic/Latinx (H/L), nor in the cancer survivors who live in these communities. Prior studies have suggested that some vulnerable populations have lowered willingness to vaccinate (e.g., for influenza) than other groups. This study will explore the role of the high burden of SDOH barriers and selected socio-cultural factors such as perceived risk, medical mistrust, and source of health information. Methods: Data for this study are from 252 CT residents, collected from August - December, 2020 using Qualtrics, an online survey platform. Using an extensive network of community partners, we recruited through list serves and social media, targeting communities known to be most impacted by the pandemic. The intent was to enroll a population that was similar to the racial/ethnic sociodemographic profile of the city of New Haven, while oversampling cancer survivors. Using SAS 9.4, we conducted descriptive and multivariate analyses to identify the role of SDOH in willingness to vaccinate. Results: The study population was disproportionately African American/Black (23.5%) and Hispanic/Latinx (17.5%) and included 83 (32.9%) cancer survivors. In this high-risk population, 38.9% of the sample were unwilling or uncertain whether they would vaccinate against Covid-19 in the future. In multivariate adjusted model, individuals reporting at least one SDOH barrier (food insecurity, trouble paying utilities bills, or housing instability) were significantly less likely to vaccinate (odds ratio=2.26;95% Confidence Interval 1.17-4.36). Other significant predicators included low perceived risk and lacking confidence in information provided through the health care system. Conclusion: Social determinants of health play a critical role in predicting intent to vaccinate for COVID-19. Special efforts are needed to ensure that vulnerable populations understand their individual risk, the benefits and risks of getting the COVID-19 vaccine, with interventions aimed at enlisting trusted entities that may not be recognized as traditional sources of health information.