Is Residential Racial Segregation Related to COVID-19 Vaccine Uptake?

This entry is part 17 of 17 in the series July 2023

We examined the association between residential segregation and COVID-19 vaccination rates, and found that overall, the association was positive, but residential segregation was associated with lower levels of vaccination in counties with the highest proportion of Black residents.

Disparities in vaccine uptake arise from a combination of individual and community-level factors, many of which can be traced back to longstanding systemic inequities and institutionalized racism. Given limited resources, it is important to tailor equitable vaccine distribution efforts to the communities that are most at risk. Some examples of equity-focused vaccine distribution campaigns include those deployed by members of the National COVID-19 Resiliency Network (NCRN), which was created by the Morehouse School of Medicine (MSM) under the National Infrastructure for Mitigating the Impact of COVID-19 within Racial and Ethnic Minority Communities (NIMIC) Initiative. For example, in collaboration with NCRN, the University of Texas at El Paso (UTEP) hosted a series of mobile vaccination clinics among migrant workers that resulted in 2100 people being vaccinated.

To support partners in assessing community needs and priorities and to facilitate monitoring and evaluating equitable COVID-19 initiatives, NCRN developed a data platform to support the work of the coalition. The MSM NCRN Data Platform, created in collaboration with KPMG LLP, offers users a centralized data repository. It brings together various publicly available data sources, including the CDC, academic centers, the US Census, the American Community Survey, and local public health agencies across the United States. Updated weekly, this platform integrates over 600 data elements related to COVID-19, health care access, social drivers of health, economic indicators, and chronic disease burden at the zip code tabulation area and county levels. It also has several composite indices around access to essential services, economic health, and COVID-19 burden and acceleration. Most importantly, this platform allows users to visualize disparities among places with high concentrations of NCRN priority populations compared to other places at the national or state level.

Because residential racial segregation has been linked to higher rates of COVID-19 infections and deaths, we set out to study whether more segregated communities experienced disparities in COVID-19 vaccine access and uptake using this data platform to support our analysis. In a recent article titled Association Between Racial Segregation and COVID-19 Vaccination Rates,” we used the MSM NCRN Database to study the association between residential segregation and COVID-19 vaccination rates across the United States. We used a measure of residential segregation called the dissimilarity index, and we examined county residential segregation between the Black and White populations in this study.

What We Found

More segregated counties had slightly higher levels of COVID-19 vaccination overall. However, in the analysis process, we discovered nuances that highlight the importance of methodological decisions when studying disparities in COVID-19 vaccinations.

First, including socio-demographic factors in our models diminished the relationship between residential segregation and vaccination, which suggests that factors such as education, income inequality, and rurality are important mediators in the relationship between residential segregation and COVID-19 vaccination.

Read our article in JPHMP

Second, we found that residential segregation was linked to reduced vaccination rates in counties where a larger percentage of the population is Black. On the other hand, in counties with a smaller proportion of Black residents, segregation was associated with higher vaccination rates. These findings indicate that areas with a higher concentration of Black residents still experience comparatively lower vaccination rates. Vaccinations among non-Black residents may be driving the positive association between the dissimilarity index and the proportion fully vaccinated in predominantly White counties.

These findings offer lessons for both policy makers and researchers. Researchers interested in modeling the relationship between residential segregation and health outcomes like COVID-19 vaccinations should consider the nuanced relationships at play, and account for mediating and moderating factors, examine interaction effects, and carry out stratified analyses. Policy makers can use this information to inform strategies to prioritize vaccine distribution and outreach by keeping in mind that areas with high rates of residential racial segregation and high proportions of Black residents may merit prioritization for vaccine access and outreach campaigns.

Karen Swietek is a Senior Health Economist at NORC at the University of Chicago with over 10 years of experience in health services research, statistical analysis, and quasi-experimental study design. Karen’s research includes mixed-methods studies focused on primary care, behavioral health and chronic comorbidities, alternative payment and delivery models, and health equity.

Dominic Mack is a Professor of Family Medicine and serves as Director of the National Center for Primary Care (NCPC) at Morehouse School of Medicine (MSM). He leads the promotion of health equity through research, training and application of innovative technology solutions that advance primary care systems to improve population health.

Megan Douglas is an Associate Professor in the Department of Community Health and Preventive Medicine and the Director of Research & Policy in the National Center for Primary Care at Morehouse School of Medicine. She is a licensed attorney and studies how policies can improve population health and advance health equity.

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