The Association of Social Factors and Health Insurance Coverage with COVID-19 Vaccinations and Hesitancy, July 2021

Document Type

Journal Article

Publication Date



Journal of General Internal Medicine








Background: There are racial differences in COVID-19 vaccination rates, but social factors, such as lack of health insurance or food insecurity, may explain some of the racial disparities. Objective: To assess social factors, including insurance coverage, that may affect COVID-19 vaccination as of June–July 2021 and vaccine hesitancy among those not yet vaccinated, and how these may affect racial equity in vaccinations. Design: Cross-sectional analysis of nationally representative survey data. Participants: Adults 18 to 64 participating in the Census Bureau’s Household Pulse Survey for June 23 to July 5, 2021. Main Measures: Vaccination: receipt of at least one dose of a COVID-19 vaccine. Vaccine hesitancy: among those not yet vaccinated, intent to definitely or probably not get vaccinated. Key Results: In unadjusted analyses, black adults were less likely to be vaccinated than other respondents, but, after social factors were included, including health insurance status, food sufficiency, income and education, and state-level political preferences, differences between black and white adults were no longer significant and Hispanics were more likely to be vaccinated (OR = 1.87, p <.001). Among those not yet vaccinated, black and Hispanic adults were vaccine hesitant than white adults (ORs =.37 and.45, respectively, both p <.001) and insurance status and food insufficiency were not significantly associated with vaccine hesitancy. The percent of state voters for former President Trump in 2020 was significantly associated with lower vaccination rates and with increased vaccine hesitancy. Discussion: The results indicate that much of the gap in COVID vaccination rates for minority adults are due to social barriers, rather than differences in racial attitudes. Unvaccinated minority adults expressed less vaccine hesitancy than white adults. Social barriers like food insecurity and insurance coverage could have deterred prompt COVID-19 vaccinations. Reducing these problems might help increase vaccination rates.