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COVID-19 Vaccination Rates: State-level and Subpopulation Analysis of the Household Pulse SurveyApril 14, 2021:
Update 5: March 17 to March 29
Newly available COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. The pace of COVID-19 vaccination rollout in the United States has picked up after an unsteady start earlier in the year. The country is on track to meet the current administration’s new goal of immunizing 200 million in Biden’s first 100 days in office, despite hiccups in the rollout of the Johnson & Johnson vaccine.
The initial groups prioritized for vaccination were healthcare workers on the front lines of the pandemic and nursing facility residents, many of whom are especially vulnerable to COVID-19 infection and severe outcomes. While these and other high-priority groups continue to be first in line for vaccination slots, many states have since expanded vaccine access to the general adult population. However, there are concerns that these early prioritization decisions and the existing mechanisms of the vaccine rollout—in addition to evidence that lower-income individuals, people of color, and individuals without strong connections to the health care system are less likely to get vaccinated—have created challenges in equitably distributing the COVID-19 vaccine and could worsen existing pandemic-related health inequities.
The available data have not assuaged these concerns and show patterns of lower vaccination rates among people with lower incomes and levels of education and marginalized racial and ethnic groups. The U.S. Census Bureau recently released updated data on take-up of COVID-19 vaccines from the latest wave of its Household Pulse Survey (HPS), collected March 17 - 29, 2021.1 The HPS is an ongoing, weekly tracking survey designed to measure impacts of the COVID-19 pandemic. These data provide an updated snapshot of COVID-19 vaccination rates and are the only data source to do so at the state level by subpopulation.
This blog post presents top-level findings from the new data, focusing on rates of vaccination (one or more doses) among U.S. adults (age 18 and older) living in households and comparing the results to the most recent wave of the HPS, collected March 3 - 15, 2021.2
These data represent the last release from Phase 3 of the HPS. Data collection for Phase 3.1 will begin April 14 after a two-week break to make tweaks to questionnaire content. It is anticipated that the first results from Phase 3.1 will be released on May 5, 2021. Census has indicated that it plans to continue administering the survey through December 2021.
Almost half of U.S. adults had received one or more COVID-19 vaccinations by the end of March.
According to the new HPS data, 47.0% of U.S. adults had received one or more vaccinations by March 29th, though this varied by state from a low of 4.12% in Maryland to a high of 59.6% in Alaska. At least one in two adults had received a vaccine in ten states: Alaska, Connecticut, Hawaii, Nevada, New Mexico, New York, North Dakota, Oklahoma, South Dakota, and West Virginia.
Vaccination rates increased dramatically across nearly all states; states with lower rates catching up
Nationally, adult vaccination rates were up from the previous wave of the HPS, increasing from 34.2% during March 3 - 15, 2021, to 47.0% during March 17 - 29, 2021. Many states experienced a large increase in their vaccination rates. The size of these increases varied from a 5.7 percentage point (PP) increase in Vermont to a 20.0 PP increase in New Mexico. Twelve states saw increases of 15.0 PP or larger.
Percent of Adults Who Had Received a COVID-19 Vaccine
Disparities in vaccination rates improved, but slowly and unevenly
COVID-19 vaccination rates continued to vary to a great degree by demographic and socioeconomic factors. Gaps in vaccination compared to the national average narrowed slightly for most groups, though some groups saw larger improvements. As with prior weeks, vaccination rates were lower for certain subpopulations such as Hispanic/Latino adults, Black adults, and Other/Multiracial adults, and these rates were particularly low for very-low-income adults and for adults without a high school education. More resources, increased attention, or new strategies may be needed to close the gaps for the hardest-to-reach groups.
By race and ethnicity, Asian and white adults continued to have above-average vaccination rates at 51.4% and 50.1%, respectively. Rates among Black adults (42.0%), adults identifying with “Multiple” or “Some Other” race (40.0%), and Hispanic/Latino adults (37.7%) continued to be below the national average. However, vaccination rates among Black adults, “Multiple” or “Some Other” race adults, and Hispanic/Latino adults all improved somewhat relative to the national average.
Hispanic/Latino adults had the largest relative improvement, going from 26 percent below the national average in the first half of March (25.4% vs. 34.2%) to 20 percent below the national average in the second half of March (37.7% vs. 47.0%). This was a marked improvement after consistently being 25 to 30 percent below the national average with every bi-weekly release since the beginning of January.
Percent of Adults Who Had Received a COVID-19 Vaccine by Race/Ethnicity
Gaps in vaccination rates among income levels have continued to narrow, however, Adults with household incomes below $50,000 are still falling below the national average, whereas adults with household incomes above $50,000 remain higher than the national average. Vaccination rates among adults with incomes less than $35,000 continued to improve compared to the national average. This improvement was especially large among adults with incomes between $25,000 and $34,999, going from 22 percent below the national average in the first half of March (26.7% vs. 34.2%) to just 6 percent below the national average in the second half of March (46.6% vs. 47.0%).
Percent of Adults Who Had Received a COVID-19 Vaccine by Income
Disparities by level of education remained, with adults that hold a bachelor’s degree or higher continuing to have the highest vaccination rate at 59.9% and adults without a high school diploma having the lowest vaccination rates at 29.0%. Disparities by education did narrow somewhat relative to the national average, especially for adults with a high school education or equivalent and adults with less than a high school level of education. However, adults with less than a high school level of education continued to have the lowest rates of vaccination of any of the groups analyzed here.
Percent of Adults Who Had Received a COVID-19 Vaccine by Education
Nationally, More than four in five older adults had received a COVID-19 vaccine
Nationally, 80.1% of older adults (age 65 and older) had received at least one dose of the COVID-19 vaccine, which was 33.1 PP higher than the rate among all adults (47.0%). Vaccination rates for older adults ranged from a low of 67.4% in Hawaii to a high of 90.1% in Connecticut. Hawaii was the only state to have a 65+ vaccination rate of below 70 percent.
As may be expected given the high rates of vaccination in the older adult population, rates of increase in vaccination in this group slowed somewhat in the last half of March. No state increased its 65+ vaccination rate by more than 0.43x (Oregon), whereas ten states were able to increase vaccination rates by 0.5x or more in the first half of the month. Though the 65+ vaccination rates in Alaska appeared to have fallen in the second half of March, this was more than likely a statistical artifact rather than an actual decrease.
Percent of Adults Age 65+ Who Had Received a COVID-19 Vaccine
Notes about the Household Pulse Survey Data
The estimated rates presented in this post were calculated from the count estimates published by the Census Bureau. Though these counts are accompanied by standard errors, standard errors are not able to be accurately calculated for rate estimates. Therefore, we are not able to determine if the differences we found in our analysis are statistically significant or if the estimates themselves are statistically reliable. Estimates and differences for subpopulations at the state level should be assumed to have large confidence intervals around them and caution should be taken when drawing strong conclusions from this analysis. However, the fact that these early indications of COVID-19 inequities mirror patterns of other vaccinations inequities demonstrate reason for concern.
Though produced by the U.S. Census Bureau, the HPS is considered an “experimental” survey and does not necessarily meet the Census’ high standards for data quality and statistical reliability. For example, the survey has relatively low response rates (7.2% for March 17 - 29), and sampled individuals are contacted via email and text message, asking them to complete an internet-based survey. These issues in particular could be potential sources of bias but come with the tradeoffs of increased speed and flexibility in data collection as well as lower costs. A future post will investigate differences between COVID-19 vaccination rates estimated from survey data (such as the HPS) and administrative sources. The estimates presented in this post are based on responses from 77,104 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.
Previous Blogs in this Series
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 4: 3/3 - 3/15) (SHADAC Blog)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 3: 2/17 - 3/1) (SHADAC Blog)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 2: 2/3 - 2/15) (SHADAC Blog)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update: 1/10 - 2/1) (SHADAC Blog)
COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (1/6 - 1/18) (SHADAC Blog)
State-level Flu Vaccination Rates among Key Population Subgroups (50-state profiles) (SHADAC Infographics)
50-State Infographics: A State-level Look at Flu Vaccination Rates among Key Population Subgroups (SHADAC Blog)
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
New Brief Examines Flu Vaccine Patterns as a Proxy for COVID – Anticipating and Addressing Coronavirus Vaccination Campaign Challenges at the National and State Level (SHADAC Blog)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)
SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4th) (SHADAC Webinar)