Association of Neighborhood Disadvantage and COVID-19 and Influenza Vaccine Uptake and Positivity Among Kaiser Permanente Washington Flu Vaccine Effectiveness Subjects, 2018 – 2022

Neighborhoods with high Area Deprivation Index (ADI) scores have been linked to an increased risk of viral transmission and lower vaccine uptake. Subsequently, ADI has informed public health efforts and interventions at the neighborhood level, especially in the context of the COVID-19 pandemic. Understanding granular patterns and disparities in vaccine uptake and viral transmission is crucial for mitigating future outbreaks and allocating resources effectively. Further, gaining insights into the association between ADI and viral outcomes could provide valuable guidance on whether future studies on vaccine effectiveness should consider ADI as a significant confounding factor. This study examined the relationship between ADI and influenza and COVID-19 vaccine uptake and test positivity, utilizing individual-level data from the U.S. Influenza Vaccine Effectiveness Network (FluVE) studies conducted at Kaiser Permanente in Washington (KPWA) between 2018 and 2022. Subjects were categorized into low or high-disadvantaged neighborhoods based on their residential addresses, and outcomes were assessed using baseline surveys, electronic health records, and laboratory results.The overall study population included 6,092 subjects over 18 years old, divided into two analysis cohorts: Influenza and COVID-19. Multivariate logistic regression analyses indicated that ADI was associated with COVID-19 vaccine uptake (Odds Ratio [OR]: 0.89; 95% Confidence Interval [CI]: 0.71, 1.10) but not influenza vaccination (OR: 1.03, 95% CI: 0.89, 1.18), influenza positivity (OR: 1.16, 95% CI: 0.99, 1.37) or COVID-19 positivity (OR: 0.89, 95% CI: 0.71, 1.10). Subjects living in high disadvantaged neighborhoods had lower odds of being fully vaccinated against COVID-19 compared to individuals in low-disadvantaged neighborhoods. Overall, findings suggest that neighborhood deprivation as measured by ADI is still important for emergent vaccine rollouts. ADI was not a confounder in estimates of influenza vaccine effectiveness. As new vaccines are developed and distributed, future public health emergency and Advisory Committee on Immunization Practices policies should include considerations to prioritize resources and focus on disadvantaged areas.