Perceived Medical Care Quality During COVID-19 Illness Links Socioeconomic Disadvantage to Vaccine Hesitancy

Abstract

Maximizing vaccine uptake critical for the optimal implementation of COVID-19 immunization programs in the United States. The present study investigates COVID-19 vaccine attitudes in individuals with history of COVID-19 infection (n=1,584), rendering it uniquely positioned to understand how variation in individual experiences during illness relates to future health behavior. Data from this study were collected during February and March 2021, representing a window of the COVID-19 pandemic when information regarding COVID-19 vaccine safety and efficacy was limited. Binomial regression identified five sociodemographic predictors for decreased COVID-19 vaccine receptivity: greater objective and perceived socioeconomic risk, younger age, female gender, and history of mood or anxiety disorder(s). Principal component analysis was used to create three composite variables that measure distinct COVID-19 related experiences: infection-related health impacts, pandemic-related psychosocial disruption, and perceived quality of medical care during COVID-19 illness. Neither infection-related impacts nor psychosocial disruption were related to vaccine receptivity after adjusting for related sociodemographic predictors. However, worse perceived care quality during COVID-19 infection predicted lower COVID-19 vaccine receptivity and partially mediated the association between objective socioeconomic risk and COVID-19 vaccine receptivity. These findings highlight patient-reported care quality during illness as a novel target that may increase vaccine uptake among socioeconomically vulnerable populations.