Racial/Ethnic Disparities in State-Level COVID-19 Vaccination Rates and Their Association with Structural Racism

Introduction Racial disparities in COVID-19 morbidity and mortality have been well-documented. However, there may also be racial disparities in COVID-19 vaccination rates which, if present, would further exacerbate the existing disparities. No previously published articles have identified and quantified potential racial disparities in vaccination throughout the USA at any geography lower than the national level. Methods Using data compiled from state health departments, we calculated racial disparities in COVID-19 vaccination for the Black and Hispanic populations compared to the White population in each state. We explored the relationship between a state-level index of structural racism and the observed differences in the racial disparities in COVID-19 vaccination across states for both the Black and Hispanic populations by conducting linear regression analyses. Results Racial disparities in COVID-19 vaccination were present for both the Black and Hispanic populations in the overwhelming majority of states. There were vast differences between the states in the magnitude of the racial disparity in race-specific vaccination rates. These differences were largely explained by differences in the level of structural racism in each state. The relationship between structural racism and the racial disparities in vaccination was not entirely explained by racial differences in vaccine hesitancy or political affiliation. Conclusions There are marked racial disparities in COVID-19 vaccination throughout the USA, and structural racism is strongly associated with the magnitude of these disparities. Efforts to reduce these disparities must address not only individual behavior but must also confront the structural barriers that are inhibiting equitable vaccine distribution.