Background: COVID-19 vaccination uptake is associated with demographic characteristics such as age, sex, and ethnicity-race in the United States (U.S.). Prior research predominantly analyzed COVID-19 vaccination uptake unidimensionally, limiting insights into multidimensional demographic inequalities. Multidimensional studies provide a closer insight into vaccination inequality and assist in designing more effective vaccination strategies. Objectives: Review descriptive studies of the COVID-19 vaccination uptake across combinations of at least two of the three key demographic characteristics: age, sex, and ethnicity-race in the U.S. Methods: A systematic review was performed using the Joanna Briggs Institute methodology and adhering to the PRISMA-ScR principles for reporting. Six impartial reviewers examined all of the papers. The data were obtained using a tailored data extraction template. Results: A total of 2793 records were initially downloaded, 461 of them were dropped for duplication, and 2332 were reviewed. Based on the title and abstract reviews, 2115 records were excluded. After reviewing the full text of the remaining records, 212 more records were excluded. The remaining six records were reviewed to identify and compare their population, study period, data, the studied dose number, methodology, and results. Conclusions: Multidimensional COVID-19 vaccine uptake analyses are rare and mostly focused on the dose-one vaccination. Improving researchers’ access to immunization registry data while preserving data security is a prerequisite for such analyses.

Background: Infectious diseases accounted for approximately 18.4% of global mortality in 2019. According to the World Health Organization (WHO), vaccines are available for about 30 potentially lethal diseases. Vaccination prevents substantial mortality and hospitalization. However, its ability to improve overall public health depends on equitable access across all populations, regardless of race, ethnicity, education, or socioeconomic status. Objectives: This study aims to examine how disparities in social determinants of health (SDOH) affect COVID-19 vaccination uptake across Jefferson County, Kentucky. Using ZIP code–level spatial mapping, this study investigates the intersection of SDOH, racial composition, and geographic characteristics to identify inequities and inform equitable interventions. Methods: Data from the Kentucky Immunization Registry (KYIR) were analyzed to assess two-dose COVID-19 vaccination rates at the ZIP code and regional levels in Jefferson County, Kentucky. Vaccination rates were stratified by race and ethnicity and linked with SDOH, including education, employment, insurance status, and income, obtained from the 2021 American Community Survey. Results: By May 2021, vaccination rates ranged from 25.9% in the West region to 57.0% in the Inner East region; by May 2022, these rates increased to 46.2% and 73.9%, respectively. White residents consistently had the highest two-dose vaccination rates (66.4% by May 2022), while Black and Hispanic residents had lower rates (45.7% and 43.9%, respectively). Vaccination rates were strongly correlated with SDOH, especially educational attainment, average family income, and employment rate, underscoring the role of socioeconomic inequities in vaccination disparities. Conclusions: Geographical and racial disparities emphasize the influence of social and economic inequality on vaccine uptake.

Understanding how vaccination-event characteristics relate to doses administered can inform public health delivery strategies. This study examined associations between modifiable characteristics of community-based COVID-19 vaccination events and doses administered per event. We conducted a retrospective analysis of 631 vaccination events coordinated by the Louisville Metro Department of Public Health and Wellness (LMPHW) in Jefferson County, Kentucky, between March 2021 and May 2022. The outcome was the number of COVID-19 vaccine doses administered per event. Multivariable regression models assessed associations between event characteristics and doses administered per event. Across all events, 27,767 COVID-19 vaccine doses were administered. Each additional hour of event duration was associated with 21.6% more doses administered per event (95% CI: 14.0–29.8%). Weekend events were associated with 87.8% more doses administered per event than weekday events (95% CI: 45.7–142.0%). Compared with government-hosted events, 44.7% more doses were administered at non-profit organizations, 110.0% more at business organizations, and 57.8% more at medical service providers. LMPHW-only events were associated with 198.4% more doses administered per event than partnered events (95% CI: 120.1–304.6%). Principal findings were generally consistent across sensitivity analyses. These findings may help inform planning of future community vaccination and other immunization initiatives.