An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: A nationwide register-based study in Sweden
Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18–64 years. National Swedish re...
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| Published in: | Vaccine Vol. 40; no. 46; pp. 6640 - 6648 |
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| Main Authors: | , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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Elsevier Ltd
02.11.2022
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| ISSN: | 0264-410X, 1873-2518, 1873-2518 |
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| Abstract | Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18–64 years.
National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18–64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake.
By 12 October 2021, 76·0% of the Swedish population 18–64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage.
Our study, addressing the entire Swedish population aged 18–64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage.
SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS. |
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| AbstractList | Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64years.National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64years (n=5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake.By 12 October 2021, 76·0% of the Swedish population 18-64years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage.Our study, addressing the entire Swedish population aged 18-64years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage.SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS. AbstractBackgroundStudies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18–64 years. MethodsNational Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18–64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. FindingsBy 12 October 2021, 76·0% of the Swedish population 18–64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. InterpretationOur study, addressing the entire Swedish population aged 18–64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. FundingSciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS. Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18–64 years. National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18–64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. By 12 October 2021, 76·0% of the Swedish population 18–64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. Our study, addressing the entire Swedish population aged 18–64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS. Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years.BACKGROUNDStudies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years.National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake.METHODSNational Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake.By 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage.FINDINGSBy 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage.Our study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage.INTERPRETATIONOur study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage.SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.FUNDINGSciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS. Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18–64 years. National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18–64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. By 12 October 2021, 76·0% of the Swedish population 18–64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. Our study, addressing the entire Swedish population aged 18–64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS. BackgroundStudies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18–64 years.MethodsNational Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18–64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake.FindingsBy 12 October 2021, 76·0% of the Swedish population 18–64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage.InterpretationOur study, addressing the entire Swedish population aged 18–64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage.FundingSciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS. |
| Author | Lundberg, L. Hammar, N. Ng, N. Spetz, M. Nwaru, C. Nyberg, F. Rosvall, M. Gisslén, M. Li, H. Santosa, A. Leach, S. |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36210254$$D View this record in MEDLINE/PubMed https://gup.ub.gu.se/publication/319259$$DView record from Swedish Publication Index (Göteborgs universitet) http://kipublications.ki.se/Default.aspx?queryparsed=id:151108247$$DView record from Swedish Publication Index (Karolinska Institutet) |
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| ContentType | Journal Article |
| Copyright | 2022 The Author(s) The Author(s) Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved. 2022. The Author(s) 2022 The Author(s). Published by Elsevier Ltd. 2022 |
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| DOI | 10.1016/j.vaccine.2022.09.065 |
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| License | This is an open access article under the CC BY license. Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
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| References_xml | – reference: Folkhälsomyndigheten [FHM], Statistik för vaccination mot covid-19 [Statistics regarding vaccination against Covid-19]. Available online: https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utbrott/aktuella-utbrott/covid-19/statistik-och-analyser/statistik-over-registrerade-vaccinationer-covid-19/. 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A Population Epidemiology Approach Using Register Linkage (SCIFI-PEARL) publication-title: Clin Epidemiol doi: 10.2147/CLEP.S312742 – volume: 94 start-page: 41 year: 2021 ident: 10.1016/j.vaccine.2022.09.065_b0105 article-title: Predictors of COVID-19 vaccine hesitancy in the UK household longitudinal study publication-title: Brain Behav Immun doi: 10.1016/j.bbi.2021.03.008 – volume: 5 start-page: 189 issue: 2 year: 1994 ident: 10.1016/j.vaccine.2022.09.065_b0135 article-title: The evolving concept of the healthy worker survivor effect publication-title: Epidemiology doi: 10.1097/00001648-199403000-00009 – volume: 21 start-page: 2104 year: 2021 ident: 10.1016/j.vaccine.2022.09.065_b0125 article-title: Racial differences in institutional trust and COVID-19 vaccine hesitancy and refusal publication-title: BMC Public Health doi: 10.1186/s12889-021-12195-5 – volume: 9 start-page: 900 issue: 8 year: 2021 ident: 10.1016/j.vaccine.2022.09.065_b0140 article-title: COVID-19 Vaccine Hesitancy-A Scoping Review of Literature in High-Income Countries publication-title: Vaccines (Basel) doi: 10.3390/vaccines9080900 – volume: 69 start-page: 511 issue: 3 year: 2021 ident: 10.1016/j.vaccine.2022.09.065_b0115 article-title: Young Adult Perspectives on COVID-19 Vaccinations publication-title: J Adolesc Health doi: 10.1016/j.jadohealth.2021.06.003 – volume: 584 start-page: 430 issue: 7821 year: 2020 ident: 10.1016/j.vaccine.2022.09.065_b0075 article-title: Factors associated with COVID-19-related death using OpenSAFELY publication-title: Nature doi: 10.1038/s41586-020-2521-4 – volume: 10 start-page: 265 issue: 2 year: 2022 ident: 10.1016/j.vaccine.2022.09.065_b0110 article-title: Factors Affecting Young Adults’ Decision Making to Undergo COVID-19 Vaccination: A Patient Preference Study publication-title: Vaccines (Basel) doi: 10.3390/vaccines10020265 – ident: 10.1016/j.vaccine.2022.09.065_b0065 doi: 10.1101/2021.11.10.21266124 – volume: 11 year: 2021 ident: 10.1016/j.vaccine.2022.09.065_b0085 article-title: Understanding the complexity of socioeconomic disparities in smoking prevalence in Sweden: a cross-sectional study applying intersectionality theory publication-title: BMJ Open doi: 10.1136/bmjopen-2020-042323 – volume: 9 start-page: 1424 issue: 12 year: 2021 ident: 10.1016/j.vaccine.2022.09.065_b0150 article-title: Assessing Acceptability of COVID-19 Vaccine Booster Dose among Adult Americans: A Cross-Sectional Study publication-title: Vaccines (Basel) doi: 10.3390/vaccines9121424 – ident: 10.1016/j.vaccine.2022.09.065_b0095 – volume: 13 start-page: 388 year: 2013 ident: 10.1016/j.vaccine.2022.09.065_b0020 article-title: Social determinants of health and seasonal influenza vaccination in adults ≥65 years: a systematic review of qualitative and quantitative data publication-title: BMC Public Health doi: 10.1186/1471-2458-13-388 – volume: 24 start-page: 659 issue: 11 year: 2009 ident: 10.1016/j.vaccine.2022.09.065_b0070 article-title: The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research publication-title: Eur J Epidemiol doi: 10.1007/s10654-009-9350-y – ident: 10.1016/j.vaccine.2022.09.065_b0030 – volume: 7 year: 2021 ident: 10.1016/j.vaccine.2022.09.065_b0050 article-title: Assessing COVID-19 Vaccine Uptake and Effectiveness Through the North West London Vaccination Program: Retrospective Cohort Study publication-title: JMIR Public Health Surveill doi: 10.2196/30010 – year: 2021 ident: 10.1016/j.vaccine.2022.09.065_b0015 article-title: Influenza, shingles and pneumococcal vaccine uptake, offer and refusal in adult populations at high-risk for COVID-19: a UK population-based cohort study publication-title: SSRN Electronic Journal – volume: 16 start-page: 1107 year: 2017 ident: 10.1016/j.vaccine.2022.09.065_b0025 article-title: Socioeconomic differences in childhood vaccination in developed countries: a systematic review of quantitative studies publication-title: Expert Rev Vaccines doi: 10.1080/14760584.2017.1381020 – volume: 12 year: 2022 ident: 10.1016/j.vaccine.2022.09.065_b0100 article-title: Characteristics associated with COVID-19 vaccine uptake among adults aged 50 years and above in England (8 December 2020-17 May 2021): a population-level observational study publication-title: BMJ Open doi: 10.1136/bmjopen-2021-055278 – volume: 18 start-page: 2004808 issue: 1 year: 2022 ident: 10.1016/j.vaccine.2022.09.065_b0145 article-title: “It seems impossible that it’s been made so quickly”: a qualitative investigation of concerns about the speed of COVID-19 vaccine development and how these may be overcome publication-title: Hum Vaccin Immunother doi: 10.1080/21645515.2021.2004808 – ident: 10.1016/j.vaccine.2022.09.065_b0005 |
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| Snippet | Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This... AbstractBackgroundStudies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on... BackgroundStudies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older... |
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| SubjectTerms | Adolescent Adult Adults Aged Allergy and Immunology Comorbidity Coronaviruses COVID-19 COVID-19 - epidemiology COVID-19 - prevention & control COVID-19 infection COVID-19 Vaccines Folkhälsovetenskap, global hälsa och socialmedicin Heterogeneity Humans Immunization income Infectious Medicine Infektionsmedicin Male males Middle Aged Older people Public Health, Global Health and Social Medicine Regression analysis Regression models Sociodemographics Subgroups Sweden Sweden - epidemiology Vaccination Vaccination Coverage Vaccines Young Adult |
| Title | An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: A nationwide register-based study in Sweden |
| URI | https://www.clinicalkey.com/#!/content/1-s2.0-S0264410X22011860 https://www.clinicalkey.es/playcontent/1-s2.0-S0264410X22011860 https://dx.doi.org/10.1016/j.vaccine.2022.09.065 https://www.ncbi.nlm.nih.gov/pubmed/36210254 https://www.proquest.com/docview/2727397397 https://www.proquest.com/docview/2723487381 https://www.proquest.com/docview/2986492139 https://pubmed.ncbi.nlm.nih.gov/PMC9515344 https://gup.ub.gu.se/publication/319259 http://kipublications.ki.se/Default.aspx?queryparsed=id:151108247 |
| Volume | 40 |
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