Preventive care services, such as immunization, are important tools for improving population health. The COVID-19 pandemic sparked an accelerated development of vaccines to stem the tide of its rapid spread and negative long-term health outcomes. As COVID-19 vaccines rolled out and became more available, many people chose to protect themselves and others through immunization, while other people opted not to be vaccinated for various reasons.

As the pandemic wore on, it became apparent that disparities in COVID-19 vaccine rates varied greatly in the United States despite extraordinary scientific efforts and economic incentives to get shots in arms as quickly as possible.^1-3 Many studies have since focused on understanding the reasons why some people have not been vaccinated.

Some researchers attribute differences in vaccine uptake to demographic variables, such as race and ethnicity. Notably, these studies concentrated on these disparities at one point in time.^2,4,5 Our team thought it worth examining vaccination uptake over time, particularly following the widespread availability of the COVID-19 vaccine to understand whether and how differences have evolved.

In our “Disparities in Preventive Care Utilization at the Intersection of Socioeconomic and Demographic Characteristics: A Survival Analysis of COVID-19 Vaccination Uptake in the United States” study, we explored factors associated with the likelihood of being vaccinated at 25 time points over a two-year period from December 2020 to December 2022.

Using publicly available data from the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), we analyzed self-reported timing of the first dose of COVID-19 vaccine in 29 US states that incorporated the COVID-19 vaccination module into their annual survey. Educational attainment and household income were used to represent socioeconomic status while assessing the differences in uptake across groups over time. Socioeconomic differences were further assessed within demographic characteristics such as age-group, sex, and race and ethnicity. Noteworthy time points included March 2021 (expansion of COVID-19 vaccine to all Americans via Emergency Use Authorization), August 2021 (first COVID-19 vaccine approved by the FDA), and January 2022 (second COVID-19 vaccine approved by the FDA).

Summary of Findings

• 74.3% of participants reported a first dose of a COVID-19 vaccine between December 2020 to December 2022.
• Higher income and college education were associated with greater likelihood of getting the COVID-19 vaccine.
• Lower vaccination rates in lower income/education groups persisted across age groups, sex, and race/ethnicity sub-groups.
• As COVID-19 vaccines became available to all, differences in vaccination rates between high and low socioeconomic groups became apparent and remained consistent over time.

Our results can offer an informative backdrop when thinking about strategies for increasing vaccine uptake in the future. Specifically, creating targeted public health interventions aimed at groups who demonstrated the lowest uptake trend over time, such as males, younger adults (18-49 years old) with high school education, and adults living in rural areas.

For more information, read “Disparities in Preventive Care Utilization at the Intersection of Socioeconomic and Demographic Characteristics: A Survival Analysis of COVID-19 Vaccination Uptake in the United States” in the September 2025 issue of the Journal of Public Health Management and Practice.

Co-author Acknowledgement

We would like to acknowledge and thank our co-authors, Santu Ghosh, PhD; Benjamin E. Ansa, PhD; and K.M. Monirul Islam, PhD. Their expertise in biostatistics, epidemiology and infectious diseases, respectively, informed the study design and discussion.

References:

1. Kriss JL, Hung MC, Srivastav A, et al. COVID-19 vaccination coverage, by race and ethnicity—National Immunization Survey Adult COVID module, United States, December 2020-November 2021. MMWR Morb Mortal Wkly Rep. 2022;71(23):757-763. doi:10.15585/mmwr.mm7123a2.

2. Williams AM, Clayton HB, Singleton JA. Racial and ethnic disparities in COVID-19 vaccination coverage: the contribution of socioeconomic and demographic factors. Am J Prev Med. 2022;62 (4):473-482. doi:10.1016/j.amepre.2021.10.008.

3. Jean-Jacques M, Bauchner H. Vaccine distribution-equity left behind? JAMA. 2021;325(9):829-830. doi:10.1001/jama.2021.1205.

4. Honeycutt CC, Contento J, Kim J, Patil A, Balu S, Sendak M. Assessment of practices affecting racial and ethnic COVID-19 vaccination equity in 10 Large US cities. J Public Health Manag Pract. 2022;28(6):E778–E788. doi:10.1097/PHH.0000000000001610.

5. Siegel M, Critchfield-Jain I, Boykin M, et al. Racial/ethnic disparities in state-level COVID-19 vaccination rates and their association with structural racism. J Racial Ethn Health Disparities. 2022;9(6):2361-2374. doi:10.1007/s40615-021-01173-7.

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Biplab Kumar Datta, PhD, is an Assistant Professor in the School of Public Health at Augusta University. He received PhD in Economics from the Georgia State University and previously worked in the US Centers for Disease Control and Prevention (CDC). His research focuses on how psychosocial factors influence health outcomes and behaviors.

 

Jennifer E. Jaremski, MPA, CPH, is a Research Associate in the Institute of Public and Preventive Health within the School of Public Health at Augusta University. She brings her expertise in project management and professional communications to her work to support faculty in all aspects of their research efforts.

 

J. Aaron Johnson, PhD, is a Professor and Associate Dean (Research) in the School of Public Health at Augusta University and the Director of the Institute of Public and Preventive Health (IPPH). He received PhD in Sociology from the University of Georgia. His research is focused on the implementation of evidence-based practices in substance abuse prevention and treatment.