Evidence map›Paper›PMID 41457208›Full record

ArticleBMC geriatrics2025

Understanding COVID-19 vaccine hesitancy among older adults in post-zero-COVID China: a predictive modeling study.

Enming Zhang, Zhengyue Dai, Shuhui Shang, Xiaolong Wang, Jiale Hu, Xian Zhang, Daqiao Zhu, Qiong Fang

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PubMed Full text at PMC Publisher
In one paragraph

Article in BMC geriatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors.

Enming ZhangSchool of Nursing, Shanghai Jiao Tong University, Shanghai, 200025, China.
Zhengyue DaiSchool of Nursing, Shanghai Jiao Tong University, Shanghai, 200025, China.
Shuhui ShangSchool of Nursing, Shanghai Jiao Tong University, Shanghai, 200025, China.
Xiaolong WangSchool of Nursing, Shanghai Jiao Tong University, Shanghai, 200025, China.
Jiale HuDepartment of Nurse Anesthesia, College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA.
Xian ZhangNursing Department, Caohejing Community Health Service Center, Xuhui, Shanghai, 200235, China.
Daqiao ZhuSchool of Nursing, Shanghai Jiao Tong University, Shanghai, 200025, China. zhudaqiao@aliyun.com.
Qiong FangSchool of Nursing, Shanghai Jiao Tong University, Shanghai, 200025, China. jonesfang@sjtu.edu.cn.

Funding

3-year action plan for the construction of Shanghai's public health system (2020-2022), academic leaders cultivating project GWV-10.2-XD33Innovative Research Team of High-level Local University in Shanghai SHSMU-ZDCX20212801
6 · The paper itself

Abstract

backgroundThe inadequate vaccination rates observed in China's older population underscore the urgent need for immediate action to accelerate the immunization campaign and mitigate the consequences of adjusting the zero COVID-19 strategy.

objectiveThis study's objective was to identify key predictors of COVID-19 vaccine hesitancy among older adults in China during the post-zero-COVID period and to develop interpretable models to inform the development of targeted intervention strategies.

methodsWe conducted a cross-sectional study between January and March 2023, sampling 647 older persons across fifteen Chinese provinces. Predictors included sociodemographic characteristics, health status, psychological antecedents of vaccination, perceptions related to the COVID-19, and mental health. Group LASSO regression was employed for feature selection, followed by binary multivariable logistic regression and Random Forest modeling. SHapley Additive Explanations (SHAP) was used to illuminate the variable significance.

resultsAmong the participants, the mean age was 68.36 ± 6.26 years, and 49.9% were male. The prevalence of vaccine hesitancy was 53.3% (95% CI, 49.5%-57.2%). Significant predictors of reduced vaccine hesitancy identified in the logistic regression model included elevated confidence (β = -0.852, P < 0.001), increased fear of COVID-19 (β = -0.060, P = 0.002), and residence in the Midlands (β = -0.840, P = 0.007) or Western regions (β = -0.899, P = 0.004) relative to the Eastern region. Heightened perceived constraint (β = 0.390, P < 0.001) significantly predicted higher vaccine hesitation. The logistic regression model (AUC = 0.827) and Random Forest model (AUC = 0.808) demonstrated high predictive performance. SHAP analysis confirmed the importance of confidence, constraints, region, COVID-19 vaccination status, education level, and collective responsibility in shaping individual-level predictions.

conclusionCOVID-19 vaccine hesitancy among older adults in China is shaped by psychological attitudes, structural barriers to access, and changing risk perceptions following the post-zero-COVID strategy era. Our study demonstrates that interpretable modeling effectively identifies these key drivers, providing a clear evidence base for developing targeted public health strategies.

Indexed as

COVID-19COVID-19 VaccinesVaccinationVaccination HesitancyAgedAged, 80 and overChinaCross-Sectional StudiesFemaleHumansMaleMiddle AgedSARS-CoV-2COVID-19 VaccinesChinaCOVID-19Machine learningOlder adultsPredictive modelingVaccine hesitancy

Identifiers

PMID41457208
PMCPMC12866358

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LicenceCC BY-NC-ND
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.