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Factors Associated With COVID-19 Vaccine Receipt by Health Care Personnel at a Major Academic Hospital During the First Months of Vaccine Availability

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

Question  What was the COVID-19 vaccine uptake among health care personnel (HCP) shortly after availability, and what factors were associated with uptake?

Findings  In this cross-sectional study of 12 610 HCP at a major US academic hospital, two-thirds received a first dose within the first 4 months; 98% of those received 2 doses. Adjusted for age, sex, job position, and area-level social vulnerability, Black or African American and multiracial HCP were less likely to receive the vaccine compared with White HCP, with narrower disparities observed for nurses and no disparities found among physicians.

Meaning  These findings indicate the presence of racial and ethnic disparities in HCP vaccine uptake, except among physicians.


Importance  Several COVID-19 vaccines have been authorized in the US, yet preliminary evidence suggests high levels of vaccine hesitancy and wide racial, ethnic, and socioeconomic disparities in uptake.

Objective  To assess COVID-19 vaccine acceptance among health care personnel (HCP) during the first 4 months of availability in a large academic hospital, compare acceptance with previously measured vaccine hesitancy, and describe racial, ethnic, and socioeconomic disparities in vaccine uptake.

Design, Setting, and Participants  This cross-sectional study included 12 610 HCP who were offered COVID-19 vaccination at a major academic hospital in Philadelphia between December 16, 2020, and April 16, 2021.

Exposures  For each HCP, data were collected on occupational category, age, sex, race and ethnicity (Asian or Pacific Islander, Black or African American [Black], Hispanic, White, and multiracial), and social vulnerability index (SVI) at the zip code of residence.

Main Outcomes and Measures  Vaccine uptake by HCP at the employee vaccination clinic.

Results  The study population included 4173 men (34.8%) and 7814 women (65.2%) (623 without data). A total of 1480 were Asian or Pacific Islander (12.4%); 2563 (21.6%), Black; 452 (3.8%), Hispanic; 7086 (59.6%), White; and 192 (1.6%), multiracial; 717 had no data for race and ethnicity. The mean (SD) age was 40.9 (12.4) years, and 9573 (76.0%) received at least 1 vaccine dose during the first 4 months of vaccine availability. Adjusted for age, sex, job position, and SVI, Black (relative risk [RR], 0.69; 95% CI, 0.66-0.72) and multiracial (RR, 0.80; 95% CI, 0.73-0.89) HCP were less likely to receive vaccine compared with White HCP. When stratified by job position, Black nurses (n = 189; 62.8%), Black HCP with some patient contact (n = 466; 49.9%), and Black HCP with no patient contact (n = 636; 56.3%) all had lower vaccine uptake compared with their White and Asian or Pacific Islander counterparts. Similarly, multiracial HCP with some (n = 26; 52.0%) or no (n = 48; 58.5%) patient contact had lower vaccine uptake. In contrast, Black physicians were just as likely to receive the vaccine as physicians of other racial and ethnic groups.

Conclusions and Relevance  In this cross-sectional study, more than two-thirds of HCP at a large academic hospital in Philadelphia received a COVID-19 vaccine within 4 months of vaccine availability. Although racial, ethnic, and socioeconomic disparities were seen in vaccine uptake, no such disparities were found among physicians. Better understanding of factors driving these disparities may help improve uptake.

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Article Information

Accepted for Publication: September 28, 2021.

Published: December 1, 2021. doi:10.1001/jamanetworkopen.2021.36582

Correction: This article was corrected on January 24, 2022, to correct the spelling of author Usama Bilal’s surname, which had been misspelled in the byline and affiliations.

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

Corresponding Author: Judith Green-McKenzie, MD, MPH, Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce St, Philadelphia, PA 19104 (Judith.McKenzie@pennmedicine.upenn.edu).

Author Contributions: Drs Green-McKenzie and Shofer 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: Green-McKenzie, Momplaisir, Kuter, O'Donnell, Al-Ramahi, Kasbekar, Sullivan, Okala, Brennan.

Acquisition, analysis, or interpretation of data: Green-McKenzie, Shofer, Momplaisir, Kuter, Kruse, Bilal, Behta.

Drafting of the manuscript: Green-McKenzie, Shofer, Kruse, Al-Ramahi.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Shofer, Momplaisir, Kruse, Bilal.

Administrative, technical, or material support: Green-McKenzie, Kruse, Behta, Al-Ramahi, Kasbekar, Sullivan, Okala, Brennan.

Supervision: Green-McKenzie, O'Donnell.

Conflict of Interest Disclosures: Dr Kuter reported serving as a consultant for Moderna during the conduct of the study. No other disclosures were reported.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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