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Racial/Ethnic Differences in COVID-19 Vaccine Hesitancy Among Health Care Workers in 2 Large Academic Hospitals

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the differences in COVID-19 vaccine hesitancy by race/ethnicity among health care workers (HCWs)?

Findings  This survey study of 10 871 HCWs from 2 academic hospitals found that, compared with White HCWs, vaccine hesitancy was increased nearly 5-fold among Black HCWs, 2-fold among Hispanic or Latino HCWs, and by nearly 50% among Asian HCWs and HCWs who were members of other racial/ethnic groups.

Meaning  These findings suggest that interventions focused on addressing vaccine hesitancy among HCWs are needed, particularly for Black and Hispanic or Latino HCWs, among whom hesitancy is highest.

Abstract

Importance  Significant differences in hesitancy to receive COVID-19 vaccination by race/ethnicity have been observed in several settings. Racial/ethnic differences in COVID-19 vaccine hesitancy among health care workers (HCWs), who face occupational and community exposure to COVID-19, have not been well described.

Objective  To assess hesitancy to COVID-19 vaccination among HCWs across different racial/ethnic groups and assess factors associated with vaccine hesitancy.

Design, Setting, and Participants  This survey study was conducted among HCWs from 2 large academic hospitals (ie, a children’s hospital and an adult hospital) over a 3-week period in November and December 2020. Eligible participants were HCWs with and without direct patient contact. A 3-step hierarchical multivariable logistic regression was used to evaluate associations between race/ethnicity and vaccine hesitancy controlling for demographic characteristics, employment characteristics, COVID-19 exposure risk, and being up to date with routine vaccinations. Data were analyzed from February through March 2021.

Main Outcomes and Measures  Vaccine hesitancy, defined as not planning on, being unsure about, or planning to delay vaccination, served as the outcome.

Results  Among 34 865 HCWs eligible for this study, 12 034 individuals (34.5%) completed the survey and 10 871 individuals (32.2%) completed the survey and reported their race/ethnicity. Among 10 866 of these HCWs with data on sex, 8362 individuals (76.9%) were women, and among 10 833 HCWs with age data, 5923 individuals (54.5%) were younger than age 40 years. (Percentages for demographic and clinical characteristics are among the number of respondents for each type of question.) There were 8388 White individuals (77.2%), 882 Black individuals (8.1%), 845 Asian individuals (7.8%), and 449 individuals with other or mixed race/ethnicity (4.1%), and there were 307 Hispanic or Latino individuals (2.8%). Vaccine hesitancy was highest among Black HCWs (732 individuals [83.0%]) and Hispanic or Latino HCWs (195 individuals [63.5%]) (P < .001). Among 5440 HCWs with vaccine hesitancy, reasons given for hesitancy included concerns about side effects (4737 individuals [87.1%]), newness of the vaccine (4306 individuals [79.2%]), and lack of vaccine knowledge (4091 individuals [75.2%]). The adjusted odds ratio (aOR) for vaccine hesitancy was 4.98 (95% CI, 4.11-6.03) among Black HCWs, 2.10 (95% CI, 1.63-2.70) among Hispanic or Latino HCWs, 1.48 (95% CI, 1.21-1.82) among HCWs with other or mixed race/ethnicity, and 1.47 (95% CI, 1.26-1.71) among Asian HCWs compared with White HCWs (P < .001). The aOR was decreased among Black HCWs when adjusting for employment characteristics and COVID-19 exposure risk (aOR, 4.87; 95% CI, 3.96-6.00; P < .001) and being up to date with prior vaccines (aOR, 4.48; 95% CI, 3.62-5.53; P < .001) but not among HCWs with other racial/ethnic backgrounds.

Conclusions and Relevance  This study found that vaccine hesitancy before the authorization of the COVID-19 vaccine was increased among Black, Hispanic or Latino, and Asian HCWs compared with White HCWs. These findings suggest that interventions focused on addressing vaccine hesitancy among HCWs are needed.

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Article Information

Accepted for Publication: June 15, 2021

Published: August 30, 2021. doi:10.1001/jamanetworkopen.2021.21931

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Momplaisir FM et al. JAMA Network Open.

Corresponding Author: Florence M. Momplaisir MD, MSHP, 423 Guardian Dr, 1201 Blockley Hall, Philadelphia, PA 19102 (florence.momplaisir@pennmedicine.upenn.edu).

Author Contributions: Drs Kuter and Faig had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Momplaisir, Kuter, Feemster, Frank, Shen, Offit, Green-McKenzie.

Acquisition, analysis, or interpretation of data: Momplaisir, Kuter, Ghadimi, Browne, Nkwihoreze, Feemster, Frank, Faig, Shen, Green-McKenzie.

Drafting of the manuscript: Momplaisir, Ghadimi, Nkwihoreze, Shen, Offit, Green-McKenzie.

Critical revision of the manuscript for important intellectual content: Momplaisir, Kuter, Ghadimi, Browne, Feemster, Frank, Faig, Shen, Green-McKenzie.

Statistical analysis: Momplaisir, Faig, Shen, Offit.

Administrative, technical, or material support: Momplaisir, Browne, Nkwihoreze, Feemster, Frank, Shen.

Supervision: Kuter, Green-McKenzie.

Conflict of Interest Disclosures: Dr Kuter reported receiving consulting fees for Moderna during the conduct of the study. Dr Feemster reported serving as an employee of Merck Research Laboratories outside the submitted work. Dr Frank reported receiving grants from Sanofi Pasteur, Moderna, Johnson & Johnson, and the National Institutes of Health outside the submitted work. No other disclosures were reported.

Funding/Support: The study was funded by the Vaccine Education Center of the Children’s Hospital of Philadelphia.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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