Associating Race, Income, and Discrimination with COVID-19 Vaccine Status, Hesitancy, and Access in the United States: A Cross-sectional Study.

There is an emerging literature exploring the role of discrimination in vaccine hesitancy, particularly among Black individuals. The goal of the present research is to explore how COVID-19 vaccine hesitancy, vaccine status, and vaccine access are associated with race, income, and discrimination. A quota sample of 798 Black/White and low/high income participants from the United States completed an online survey between March 8 and April 19, 2023. The survey assessed self-reported race, income, discrimination, vaccine hesitancy, and vaccine access. Perceived discrimination (B = .15, P = .002) and being Black (B = -.30, P < .001) were associated with higher vaccine hesitancy. Lower income White participants were less likely to be vaccinated than Black or higher income White participants (PR = .66, P = .04). The lowest vaccine access was reported by low-income White participants with high levels of discrimination and the highest access was reported by high-income Black participants with low levels of discrimination (B = -.03, P = .05). Our findings highlight the unique impact of discrimination on vaccine access and vaccine hesitancy. Further, despite previous literature identifying Black populations as having lower vaccine access, our findings suggest that lower income White participants reported the lowest vaccine access and were the least likely to be vaccinated. These findings have implications for understanding the impact of discrimination on vaccine-related beliefs and behaviors, which can inform vaccine-related communication in communities where discrimination is likely.