Volume 86, March 2024, 103221Author links open overlay panel, , , , Highlights•

Beneficiaries in disadvantaged areas often younger, Black, in rural areas or South.

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Beneficiaries in disadvantaged areas have more chronic conditions and worse health.

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Beneficiaries in disadvantaged urban areas had the lowest COVID-19 vaccine uptake.

Abstract

A variety of factors influenced the American public's experiences with the COVID-19 pandemic and initial availability and uptake of COVID-19 vaccines. To examine variation in early COVID-19 vaccine uptake based on neighborhood disadvantage along with individual sociodemographic and health characteristics, we used Spring 2021 data from the Medicare Current Beneficiary Survey (MCBS), a nationally representative, longitudinal survey of the Medicare population conducted by the Centers for Medicare & Medicaid Services. Bivariate analyses showed that beneficiaries in disadvantaged neighborhoods were less likely to have received at least one vaccine dose than those in less disadvantaged neighborhoods (49.7%, SE = 1.6 versus 66.6%, SE = 1.0, p < 0.0001). After accounting for individual characteristics, the relationship between neighborhood disadvantage and vaccine uptake was not statistically significant. However, interaction effects of neighborhood disadvantage by urbanicity showed a more complex picture, where those in disadvantaged urban areas had the lowest odds of vaccine uptake (p < 0.01). The relationship between neighborhood disadvantage and vaccination is multifaceted, requiring further research to inform future vaccination efforts targeting the most vulnerable beneficiaries.

Section snippetsFunding

This work was supported by the U.S. Department of Health and Human Services. Funding for data collection and processing of the Medicare Current Beneficiary Survey (MCBS) is provided under Contract 75FCMC19D0092; Task Order 75FCMC21F0001 by the Centers for Medicare & Medicaid Services.

Setting and population

The MCBS is a longitudinal survey of a nationally representative sample of the Medicare population (beneficiaries aged 65 years and over and younger individuals with disabilities or end-stage renal disease), conducted by the Centers for Medicare & Medicaid Services (CMS) through a contract with NORC at the University of Chicago. The MCBS collects data on beneficiary sociodemographics, health status and functioning, and healthcare utilization. The MCBS conducted three COVID-19 Supplement surveys

Characteristics of beneficiaries in disadvantaged neighborhoods

Beneficiaries living in disadvantaged neighborhoods were significantly more likely to be female, under age 65, identify as Black non-Hispanic, earn less than $25,000 annually, have less than a high school education, live in rural areas or the South, and be dually eligible for both Medicare and Medicaid. Beneficiaries in disadvantaged areas also reported more chronic conditions and being in fair/poor health (Fig. 1).

Early COVID-19 vaccine uptake

Bivariate analyses showed that beneficiaries in disadvantaged neighborhoods were

Discussion

This study confirmed that disadvantaged and less disadvantaged neighborhoods tend to differ on several sociodemographic and health-related dimensions and also revealed links between neighborhood advantage and early COVID-19 vaccine uptake. First, this study identified several beneficiary characteristics associated with living in a disadvantaged Census Block Group. Beneficiaries in disadvantaged neighborhoods were more often female, younger, Black non-Hispanic, lower-income, less educated, and

Limitations

There are several limitations to note when interpreting results. First, the ADI uses an administrative definition of “neighborhood” (Census Block Group), which may not necessarily align with respondents' perceptions of neighborhood. It is possible that one's perceived neighborhood boundaries—for example, defined as the blocks they frequent most—may have greater implications for health outcomes. Second, this study represents only a cross-section of beneficiaries' experiences during an evolving

Future directions

Place-based disadvantage contributes to health disparities. However, it can also be targeted and modified through public health policy in a way that reaches more people than individual-level interventions. This study underscores the complex relationship between neighborhood disadvantage and Medicare beneficiaries’ vaccination initiation. More research is needed to explore the relationship between neighborhood disadvantage and vaccine acceptance and confidence, barriers to vaccination, adherence

CRediT authorship contribution statement

Elise Comperchio: Writing – review & editing, Writing – original draft, Supervision, Methodology, Investigation, Formal analysis. Becky Reimer: Writing – review & editing, Writing – original draft, Methodology, Investigation, Formal analysis. Theresa Juliano: Writing – original draft, Formal analysis. Andrea Mayfield: Writing – original draft, Conceptualization. Marisa Wishart: Writing – original draft, Investigation.

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