Study finds health care coverage disparities hampering rural COVID-19 vaccination efforts

The vaccine hesitancy is just one reason why fewer people in some parts of the United States are being vaccinated against the coronavirus.

Study in magazine Lancet Regional Health found that large disparities in health care coverage, particularly in rural areas, hampered vaccination efforts during the COVID-19 pandemic. The findings point to a hidden divide in America between those with ready geographic and financial access to doctors, hospitals and clinics and those without.

University of Cincinnati epidemiologist Diego Quadros led an international team of researchers examining differences in vaccination rates across 2,417 US counties. They found that the availability of health care resources affects vaccine coverage.

The pandemic has killed more than 6.3 million people worldwide, including more than 1 million people in the United States alone. As for the country’s relatively high death rate, the researchers point to vaccination failures compared to other countries.

Quadros, an associate professor of geography in UC’s College of Arts and Sciences, said vaccination rates vary widely across the United States. While some people may be reluctant to get vaccinated because of unfounded fears or misinformation, that only tells part of the story, he said.

During the pandemic, we realized the huge health care disparity we have in this country.”

Diego Cuadros, Associate Professor of Geography, UC College of Arts and Sciences

Barriers to accessing health care include cost, insurance coverage, and transportation.

In national surveys, about 20% of the US population has reported that they do not want to be vaccinated. This does not account for the larger unvaccinated population. While more than half the population in every US state is already fully vaccinated, some states are much further ahead than others.

Quadros said low-vaccination areas saw the highest death rates from the virus during the delta and omicron waves, demonstrating the dire impact health care disparities can have on underserved communities.

Co-author Neil McKinnon, chancellor of Augusta University in Georgia, said the pandemic has caused massive disruptions to health services even in places with easy access. People visit their doctors much less often, leading to more undiagnosed cases of cancer and other diseases.

“Our study shows that these disruptions are not uniform across the United States,” McKinnon said. “Many counties, particularly those in rural areas, have experienced significant health care disruptions, including the spread of the COVID-19 vaccine itself.”

The new analysis found that people in underserved communities were up to 34 percent less likely to be vaccinated against COVID-19. They include counties in Nevada, Montana, North Dakota, South Dakota and Nebraska where vaccination rates are the lowest.

“America’s health care system needs to be improved to address historical disparities that, as our study shows, can affect decision-making at the individual level,” said study co-author and geography graduate student at Cal. Santiago Escobar University. “Our study suggests clear differences that need to be addressed.”

Co-author Phillip Coule, MD, chief medical officer of Augusta University Health in Georgia, said the study highlights the impact of vaccination in fighting diseases like COVID-19.

“Those responsible for guiding health policy must consider issues such as vaccination rates, access to care and health care disparities when assessing outcomes for COVID-19 and other conditions,” he said.


Journal reference:

Photos, DF, et al. (2022) Impact of Health Care Capacity Disparities on COVID-19 Vaccination Coverage in the United States: A Cross-Sectional Study. The Lancet Regional Health – Americas.

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