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BMC Public Health
Published in: BMC Public Health 1/2022

Open Access 01-12-2022 | COVID-19 Vaccination | Research

How education and racial segregation intersect in neighborhoods with persistently low COVID-19 vaccination rates in Philadelphia

Authors: John A. Rich, Edward J. Miech, Usama Bilal, Theodore J. Corbin

Published in: BMC Public Health | Issue 1/2022

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Abstract

Background

COVID-19 infection has disproportionately affected socially disadvantaged neighborhoods. Despite this disproportionate burden of infection, these neighborhoods have also lagged in COVID-19 vaccinations. To date, we have little understanding of the ways that various types of social conditions intersect to explain the complex causes of lower COVID-19 vaccination rates in neighborhoods.

Methods

We used configurational comparative methods (CCMs) to study COVID-19 vaccination rates in Philadelphia by neighborhood (proxied by zip code tabulation areas). Specifically, we identified neighborhoods where COVID-19 vaccination rates (per 10,000) were persistently low from March 2021 – May 2021. We then assessed how different combinations of social conditions (pathways) uniquely distinguished neighborhoods with persistently low vaccination rates from the other neighborhoods in the city. Social conditions included measures of economic inequities, racial segregation, education, overcrowding, service employment, public transit use, health insurance and limited English proficiency.

Results

Two factors consistently distinguished neighborhoods with persistently low COVID-19 vaccination rates from the others: college education and concentrated racial privilege. Two factor values together – low college education AND low/medium concentrated racial privilege – identified persistently low COVID-19 vaccination rates in neighborhoods, with high consistency (0.92) and high coverage (0.86). Different values for education and concentrated racial privilege – medium/high college education OR high concentrated racial privilege – were each sufficient by themselves to explain neighborhoods where COVID-19 vaccination rates were not persistently low, likewise with high consistency (0.93) and high coverage (0.97).

Conclusions

Pairing CCMs with geospatial mapping can help identify complex relationships between social conditions linked to low COVID-19 vaccination rates. Understanding how neighborhood conditions combine to create inequities in communities could inform the design of interventions tailored to address COVID-19 vaccination disparities.
Appendix
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Literature
1.
2.
3.
DiMaggio C, Klein M, Berry C, Frangos S. Black/African American communities are at highest risk of COVID-19: spatial modeling of new York City ZIP code–level testing results. Ann Epidemiol. 2020;51:7–13.PubMedPubMedCentralCrossRef
4.
Bilal U, Tabb LP, Barber S, Diez Roux AV. Spatial inequities in COVID-19 testing, positivity, confirmed cases, and mortality in 3 US cities: an ecological study. Ann Intern Med. 2021;174(7):936–44.PubMedCrossRef
5.
Injustice in Health. Now is the time to change the story. Ann Intern Med. 2021;174(7):1012–3.CrossRef
6.
National Academies of sciences E, medicine. In: Gayle H, Foege W, Brown L, Kahn B, editors. Framework for equitable allocation of COVID-19 vaccine. Washington, DC: The National Academies Press; 2020. p. 272.
7.
Barry V, Dasgupta S, Weller DL, Kriss JL, Cadwell BL, Rose C, et al. Patterns in COVID-19 vaccination coverage, by social vulnerability and Urbanicity—United States, December 14, 2020–may 1, 2021. Morb Mortal Wkly Rep. 2021;70(22):818.CrossRef
8.
Hughes MM, Wang A, Grossman MK, Pun E, Whiteman A, Deng L, et al. County-level COVID-19 vaccination coverage and social vulnerability—United States, December 14, 2020–march 1, 2021. Morb Mortal Wkly Rep. 2021;70(12):431.CrossRef
9.
Whiteman A, Wang A, McCain K, Gunnels B, Toblin R, Lee JT, et al. Demographic and social factors associated with COVID-19 vaccination initiation among adults aged≥ 65 years—United States, December 14, 2020–April 10, 2021. Morb Mortal Wkly Rep. 2021;70(19):725.CrossRef
10.
11.
12.
Anaele BI, Doran C, McIntire R. Visualizing COVID-19 mortality rates and African-American populations in the USA and Pennsylvania. J Racial Ethn Health Disparities. 2021;8:1–8.
13.
14.
Chen JT, Krieger N. Revealing the unequal burden of COVID-19 by income, race/ethnicity, and household crowding: US county versus zip code analyses. J Public Health Manage Pract. 2021;27(1):S43–56.CrossRef
15.
Gaynor TS, Wilson ME. Social vulnerability and equity: the disproportionate impact of COVID-19. Public Adm Rev. 2020;80(5):832–8.CrossRef
16.
Ragin CC, Fiss PC. Intersectional inequality. Intersectional Inequality: University of Chicago Press; 2016. p. 11.
17.
Hanckel B, Petticrew M, Thomas J, Green J. The use of qualitative comparative analysis (QCA) to address causality in complex systems: a systematic review of research on public health interventions. BMC Public Health. 2021;21(1):877.PubMedPubMedCentralCrossRef
18.
Ragin CC. Heterogeneity and Causal Complexity. The Comparative Method. Moving Beyond Qualitative and Quantitative Strategies. University of California Press; 2014. p. 19–32.
19.
Whitaker RG, Sperber N, Baumgartner M, Thiem A, Cragun D, Damschroder L, et al. Coincidence analysis: a new method for causal inference in implementation science. Implement Sci. 2020;15(1):1–10.CrossRef
20.
Schneider CQ, Wagemann C. Set-Theoretic Methods for the Social Sciences: A Guide to Qualitative Comparative Analysis. Cambridge: Cambridge University Press; 2012. p. 44-46.
21.
Shi C, Liao L, Li H, Su Z. Which urban communities are susceptible to COVID-19? An empirical study through the lens of community resilience. BMC Public Health. 2022;22(1):70.PubMedPubMedCentralCrossRef
22.
Spangaro J, Koziol-McLain J, Zwi A, Rutherford A, Frail M-A, Ruane J. Deciding to tell: qualitative configurational analysis of decisions to disclose experience of intimate partner violence in antenatal care. Soc Sci Med. 2016;154:45–53.PubMedCrossRef
23.
Cohen DJ, Sweeney SM, Miller WL, Hall JD, Miech EJ, Springer RJ, et al. Improving smoking and blood pressure outcomes: the interplay between operational changes and local context. Ann Fam Med. 2021;19(3):240–8.PubMedPubMedCentralCrossRef
24.
Coury J, Miech EJ, Styer P, Petrik AF, Coates KE, Green BB, et al. What’s the “secret sauce”? How implementation variation affects the success of colorectal cancer screening outreach. Implement Sci Commun. 2021;2(1):1–11.CrossRef
25.
Hickman SE, Miech EJ, Stump TE, Fowler NR, Unroe KT. Identifying the implementation conditions associated with positive outcomes in a successful nursing facility demonstration project. Gerontologist. 2020;60(8):1566–74.PubMedPubMedCentralCrossRef
26.
Petrik AF, Green B, Schneider J, Miech EJ, Coury J, Retecki S, et al. Factors influencing implementation of a colorectal cancer screening improvement program in community health centers: an applied use of configurational comparative methods. J Gen Intern Med. 2020;35(2):815–22.PubMedPubMedCentralCrossRef
27.
Yakovchenko V, Miech EJ, Chinman MJ, Chartier M, Gonzalez R, Kirchner JE, et al. Strategy configurations directly linked to higher hepatitis C virus treatment starts: an applied use of configurational comparative methods. Med Care. 2020;58(5):e31.PubMedPubMedCentralCrossRef
28.
Krieger N, Waterman PD, Spasojevic J, Li W, Maduro G, Van Wye G. Public health monitoring of privilege and deprivation with the index of concentration at the extremes. Am J Public Health. 2016;106(2):256–63.PubMedPubMedCentralCrossRef
29.
Ambuehl M, Baumgartner M, Epple R, Parkkinen V, Thiem A. cna: causal modeling with coincidence analysis. R package version 3.3.0; 2021.
30.
Baumgartner M, Ambühl M. Causal modeling with multi-value and fuzzy-set coincidence analysis. Polit Sci Res Methods. 2020;8(3):526–42.CrossRef
31.
Goertz G, Mahoney J. A tale of two cultures. A Tale of Two Cultures: Princeton University Press; 2012.CrossRef
32.
Green-McKenzie J, Shofer FS, Momplaisir F, Kuter BJ, Kruse G, Bialal U, et al. Factors associated with COVID-19 vaccine receipt by health care personnel at a major academic hospital during the first months of vaccine availability. JAMA Netw Open. 2021;4(12):e2136582-e.CrossRef
33.
Thomas K, Darling J, Cassil A. Education is now a bigger factor than race in desire for COVID-19 vaccine. Los Angeles: USC Dornsife Center for Economic and Social Research; 2021.
34.
Nguyen KH, Srivastav A, Razzaghi H, Williams W, Lindley MC, Jorgensen C, et al. COVID-19 vaccination intent, perceptions, and reasons for not vaccinating among groups prioritized for early vaccination—United States, September and December 2020. Am J Transplant. 2021;21:1650–6.PubMedPubMedCentralCrossRef
35.
Biswas N, Mustapha T, Khubchandani J, Price JH. The nature and extent of COVID-19 vaccination hesitancy in healthcare workers. J Community Health. 2021;46(6):1244–51.PubMedPubMedCentralCrossRef
36.
Khubchandani J, Sharma S, Price JH, Wiblishauser MJ, Sharma M, Webb FJ. COVID-19 vaccination hesitancy in the United States: a rapid National Assessment. J Community Health. 2021;46(2):270–7.PubMedCrossRef
37.
38.
Bajaj SS, Stanford FC. Beyond Tuskegee—vaccine distrust and everyday racism. N Engl J Med. 2021;384(5):e12.PubMedCrossRef
39.
Jaklevic MC. Surgeon fills COVID-19 testing gap in Philadelphia’s black neighborhoods. JAMA. 2021;325(1):14–6.PubMedCrossRef
40.
Snowden LR, Graaf G. COVID-19, social determinants past, present, and future, and African Americans’ health. J Racial Ethn Health Disparities. 2021;8(1):12–20.PubMedCrossRef
41.
White K, Borrell LN. Racial/ethnic residential segregation: framing the context of health risk and health disparities. Health Place. 2011;17(2):438–48.PubMedCrossRef
42.
Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep (Washington, DC : 1974). 2001;116(5):404–16.CrossRef
43.
Kawachi I, Adler NE, Dow WH. Money, schooling, and health: mechanisms and causal evidence. Ann N Y Acad Sci. 2010;1186:56–68.PubMedCrossRef
44.
Agarwal R, Dugas M, Ramaprasad J, Luo J, Li G, Gao GG. Socioeconomic privilege and political ideology are associated with racial disparity in COVID-19 vaccination. Proceed Natl Acad Sci. 2021;118(33):e2107873118.CrossRef
45.
Barry V, Dasgupta S, Weller DL, Kriss JL, Cadwell BL, Rose C, et al. Patterns in COVID-19 vaccination coverage, by social vulnerability and Urbanicity — United States, December 14, 2020–may 1, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(22):818–24.PubMedPubMedCentralCrossRef
46.
Fisher KA, Bloomstone SJ, Walder J, Crawford S, Fouayzi H, Mazor KM. Attitudes toward a potential SARS-CoV-2 vaccine: a survey of US adults. Ann Intern Med. 2020;173(12):964–73.PubMedCrossRef
47.
Sacarny A, Daw JR. Inequities in COVID-19 vaccination rates in the 9 largest US cities. JAMA Health Forum. 2021;2(9):e212415.
48.
Greckhamer T, Furnari S, Fiss PC, Aguilera RV. Studying configurations with qualitative comparative analysis: best practices in strategy and organization research. Strateg Organ. 2018;16(4):482–95.CrossRef
49.
Quintana R. Embracing complexity in social science research. Qual Quant. 2022;1-24.
50.
51.
Elnaiem AD. Intersectionality in the time of COVID-19: dispatches from a contact tracer. Am J Public Health. 2021;111(1):93–4.PubMedCrossRef
52.
Hancock A-M. When multiplication doesn't equal quick addition: examining intersectionality as a research paradigm. Perspect Polit. 2007;5(1):63–79.CrossRef
53.
Baumgartner M, Falk C. Configurational Causal Modeling and Logic Regression. Multivariate Behavioral Research. 2021;1-19.
Metadata
Title
How education and racial segregation intersect in neighborhoods with persistently low COVID-19 vaccination rates in Philadelphia
Authors
John A. Rich
Edward J. Miech
Usama Bilal
Theodore J. Corbin
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2022
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-022-13414-3

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