US residents aged 6 months or older with a primary language other than English had lower COVID-19 vaccine uptake and delays in receiving primary vaccination and booster doses than native English speakers, according to a study published today in JAMA Network Open.
HealthPartners researchers in Minnesota used electronic health records to retrospectively assess vaccine coverage and time to receipt of COVID-19 primary vaccines and first-generation (monovalent, or single-strain) and bivalent (two-strain) boosters among more than 1 million patients from December 2020 to June 2023 at a single healthcare system.
Of all patients, 53.7% were female, 58.2% were White, 14.7% were multiracial, 10.3% were Black, 5.5% were Asian, 5.0% were Hispanic, and 4.9% were younger than 5 years.
"More time spent unvaccinated or undervaccinated means longer duration of risk for poor outcomes from COVID-19, and delays in vaccination may be partly responsible for some of the disparities noted in morbidity and mortality among racial and ethnic groups in the US," the investigators wrote.
Somali, Hmong speakers had lower primary series uptake
Most patients reported English as their primary language (94.1%) and were born in the United States (91.8%). Overall primary COVID-19 vaccine series coverage was 63.7%, coverage of the first-generation booster was 64.4%, and 39.5% had received a bivalent booster.
Uptake of all three vaccine types was lower among speakers of a non-English language than among native English speakers (56.9% vs 64.1% for the primary vaccine series, 47.5% vs 65.3% for the first-generation booster, and 26.2% vs 40.3% for the bivalent booster). The adjusted hazard ratios (aHRs) were 0.86, 0.74, and 0.65, respectively.
Differences in the rate of vaccine uptake over time can alert clinicians and public health workers to vaccine hesitancy or accessibility issues within a community as well as identify the need for specific education and outreach efforts.
Patients born outside the United States had higher primary vaccine series uptake than their US-born counterparts (aHR, 1.21) and comparable uptake of the first-generation booster (aHR, 0.99) and the bivalent booster (aHR, 0.99).
COVID-19 coverage was lower among Black patients than those of other races. Vaccine uptake rose with increasing age for the primary series and first-generation booster and was lowest in those aged 17 to 29 years for bivalent boosters.
The median time to completion of the primary vaccine series was 190 days, with half receiving the full series by June 2021. The median time from primary series completion to receipt of the first-generation booster was 261 days. Of those who received a bivalent booster by the end of the study period, the median time to receipt was 57 days.
Somali speakers had a lower rate of primary vaccine series coverage (aHR, 0.74) than native English speakers, with disparities in uptake widening for first-generation (aHR, 0.34) and bivalent (aHR, 0.30) boosters. Hmong speakers had lower primary series uptake (aHR, 0.81) than English speakers. Primary vaccination coverage was lowest for speakers of languages from Central and Eastern Europe (aHR, 0.36).
Patients with a non-English primary language encountered more delays to receive the primary vaccine series and booster vaccines than native English speakers. Disparities were also noted in timing of primary series completion among patients with public compared with private health insurance (AHR, 0.37) and those younger than 30 years compared with those aged 30 to 49 years.
Importance of culturally tailored approaches
"Differences in the rate of vaccine uptake over time can alert clinicians and public health workers to vaccine hesitancy or accessibility issues within a community as well as identify the need for specific education and outreach efforts," the researchers wrote.
Giving the entire United States population up-to-date information on COVID-19 recommendations is critical, they added.
"Culturally tailored approaches to public health messaging, especially reaching patients in their primary or preferred language, are increasingly being recognized as a critical component of health equity," the authors concluded. "Ensuring availability of linguistically appropriate information about vaccine recommendations and safety may help reduce delays in vaccination and promote health equity for patients with a language preference other than English."
