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  • Feb 06, 2023

Access to Healthcare Tied to Higher COVID-19 Booster Uptake in Massachusetts: Communities at Highest Risk Least Likely to be Boosted

New study finds health insurance, a recent checkup, and proximity to primary care and vaccine providers linked to better booster rate in Mass. communities

CAMBRIDGE, Mass. — Booster shots are key to reducing risk from COVID-19, yet uptake has lagged. In a new study published Monday, researchers at Cambridge Health Alliance, Harvard Medical School, and the City University of New York Hunter College report that routine access to health care makes a big difference. The study, published in the journal Health Affairs, examined 462 Massachusetts communities (defined by ZIP codes) through April 2022, the end of the Omicron wave. It found that the rate of booster uptake was associated with the rates of insurance coverage and medical checkups, and (for low-income communities) their proximity to primary care doctors and vaccination sites.

The researchers determined each community's demographics, healthcare access, and rates of chronic disease using an array of data sources. They found higher booster uptake in areas with older and wealthier residents, and lower uptake in those with more Hispanic and Black residents. Booster rates were lower in communities where more residents had common chronic conditions like lung disease or diabetes that are linked to worse COVID-19 outcomes. In other words, with the exception of age, most major risk factors for severe COVID-19 were more common in communities with lower booster uptake.

Lack of health insurance had a large effect on booster receipt, even though COVID-19 vaccinations were free at the time of the study. For example, among the one-fifth of ZIP codes with the highest rates of insurance coverage, 68.3% of adults were boosted through April 2022. However, in the fifth of communities with the lowest coverage rates (i.e. the most uninsurance) only 39.2% were boosted. Communities where a higher proportion of residents had a medical checkup within the past year likewise had higher rates of booster uptake relative to those with lower rates of checkups. These differences persisted even with adjustment for such factors as age, income, race, and ethnicity. Closer proximity to primary care doctors and vaccination sites was linked to better booster uptake only after control for income — suggesting that distance from medical facilities is a much bigger barrier for the poor than for the affluent.

"COVID-19 vaccines have been free," noted lead author Dr. Adam Gaffney, a pulmonologist and critical care physician at Harvard Medical School and Cambridge Health Alliance. "Yet healthcare access matters— patients with a trusted physician who can provide advice on vaccines and help make them conveniently available are more likely to get boosted. Fighting COVID-19 – and future epidemics — requires universal, robust primary care for all."

Dr. Steffie Woolhandler, a primary care physician and Distinguished Professor at the City University of New York's Hunter College, noted "Medical practices too often shun poor communities and give poor and minority patients the message that they're not welcome because they can't pay. You can't reverse that message overnight when a pandemic hits. Nations like Canada and Britain, where care is free, have had higher vaccination rates and fewer COVID-19 deaths. A fairer health care system makes for a healthier nation."

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