Bernard, Sydney
Research Assistant

e hoffe108@umn.edu

Tracking Broadband Access to Monitor Access to Care

The dramatic growth of telehealth during the COVID-19 pandemic has highlighted the crucial role of broadband access in ensuring that people can obtain healthcare services. Broadband has allowed individuals to leverage telehealth technology to receive care from providers in ways that minimize the risk of COVID-19 transmission while eliminating certain access barriers regarding transportation and/or travel time. However, individuals who lack access to broadband services can face healthcare inequities as they are unable to utilize virtual services. Although COVID-19 vaccination rates are on the rise across the United States, the resurgence of cases due to the Delta variant of COVID-19 may lead to more required virtual visits. In addition, virtual access to care will remain important for individuals who live in rural areas, have transportation or mobility limitations, or otherwise would have difficulty visiting a care provider in person, even after the pandemic subsides.

Broadband Access Across the Country
Despite the important role of broadband access in obtaining virtual healthcare services, not everyone lives in a household that has broadband. Estimates from a SHADAC analysis of the American Community Survey (ACS) Public Use Microdata Sample (PUMS) files indicate that in 2019, 86.3 percent of families nationwide had access to broadband in their households.¹ Among the states, household broadband access ranged from a high of 91.2 percent in Washington to a low of 76.9 percent in Mississippi.¹ Higher rates of broadband access are clustered in states on the West Coast and the Northeast shore. States that have more rural populations tend to have lower access to broadband, with a concentration of limited access in the Southeast.¹

Percent of households with a broadband internet subscription, 2019

Source: SHADAC analysis of the 2019 American Community Survey (ACS) Public Use Microdata Sample (PUMS) files.

Broadband Access in Minnesota: Above Average, with Plans to Expand
In Minnesota, 87.9 percent of households had access to broadband in their homes in 2019, placing the state higher than the national average and with the 14th highest access to broadband across the states.¹ However, the nearly 12 percent of Minnesota households that do not have broadband access also tend to face other factors that can reduce access to healthcare, like living in less dense counties, which tend to have fewer medical providers and require patients to travel farther to access medical facilities.² In order to improve healthcare accessibility in these areas, Minnesota legislators have agreed to invest an additional $70 million in broadband coverage expansion through the Border-to-Border grant program.³ This program assists with infrastructure installation costs that broadband providers may experience when offering services to an area that has been historically unserved or underserved.³ While this grant program is not expected to expand broadband services to every household in Minnesota, it is one of the largest investments in broadband access in the state since 2014.³

Conclusion
Broadband internet has been vital for accessing healthcare during the COVID-19 pandemic. However, not every family in the U.S. has access to broadband, and this lack of access is distributed unevenly among the states. Less than 80 percent of households in Mississippi and New Mexico (76.9 percent and 78.9 percent, respectively) have broadband access while over 90% of households in Utah, Colorado, and Washington (90.5 percent, 91.1 percent, and 91.2 percent, respectively) have access to broadband internet.¹ As telehealth continues to play a role in getting needed services to individuals who face barriers to obtaining care in person, it is important to monitor broadband access as an indicator of access to care.

About the Data
The data cited here can be accessed through SHADAC’s online data tool, State Health Compare, using the measure “Percent of households with a broadband internet subscription” for the years 2016-2019. The estimates come from SHADAC’s analysis of the American Community Survey (ACS) Public Use Microdata Sample (PUMS).

Ngep, Julia
Research Assistant

e ngepx004@umn.edu

COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey

Update 6: June 9 to June 21

The COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. After several months of rolling out the various one and two-shot COVID-19 vaccines, which have included hiccups from the Johnson & Johnson vaccine, vaccination rates continue to increase at a slow but steady pace. Although the country fell short of meeting the current administration’s goal of vaccinating 70% of the adult population by July 4 (as measured by official administrative data reported to the Centers for Disease Control [CDC]), several states have achieved this goal.

Over the past several months, all states have increased COVID-19 vaccine rollout by expanding vaccine access to the general adult population and children over 12. However, there are still concerns on prioritization decisions and the existing mechanisms of the vaccine rollout—in addition to evidence that lower-income individuals, people of color, and individuals without strong connections to the health care system are less likely to get vaccinated—which have created challenges in equitable distribution of the COVID-19 vaccine and could worsen existing pandemic-related health inequities.

The available data have not assuaged these concerns, and show patterns of lower vaccination rates among people with lower levels of education, no health insurance coverage, and marginalized racial and ethnic groups. The U.S. Census Bureau recently released updated data on take-up of COVID-19 vaccines from its Household Pulse Survey (HPS), collected June 9-21, 2021. The HPS is an ongoing, biweekly tracking survey designed to measure impacts of the COVID-19 pandemic. These data provide an updated snapshot of COVID-19 vaccination rates and are the only data source to do so at the state level by subpopulation.

This blog post presents top-level findings from these new data, focusing on rates of vaccination (one or more doses) among U.S. adults (age 18 and older) living in households and comparing to results from the last half of March, the most recent time period of comparison from this ongoing blog series.

These data represent the latest release from Phase 3.1 of the HPS, which has a biweekly data collection and dissemination approach. The Census Bureau has indicated that it plans to continue administering the survey through December 2021.

Nationally, over three-fourths of adults had received a vaccination, but this varied by state
According to the new HPS data, 79.1% of U.S. adults had received one or more COVID-19 vaccinations towards the end of June¹, though this varied by state from a low of 63.9% in Mississippi to a high of 91.0% in Massachusetts. At least four in five adults had received a vaccine in 22 states and the District of Columbia.

Vaccination rates increased considerably across all states; states with lower rates catching up
Nationally, adult vaccination rates substantially increased from the last half of March, rising from 47.0% during March 17-29, 2021, to 79.1% during June 9-21, 2021. Many states experienced large increases in their vaccination rates. The size of these increases varied from an 11.2 percentage-point (PP) increase in North Dakota to a 46.1 PP increase in Massachusetts. Five states saw increases of 40.0 PP or larger: Maryland, Massachusetts, Oregon, Rhode Island, and Vermont.

Percent of Adults Who Had Received a COVID-19 Vaccine, 2021

Disparities in vaccination rates improved, but slowly and unevenly
Although there have been ongoing strategies to achieve health equity in COVID-19 vaccine rollouts, vaccination rates continued to vary to a great degree by demographic and socioeconomic factors. Gaps in vaccination compared to the national average narrowed slightly for most groups, though some saw larger improvements. As with previous iterations in this blog series, vaccination rates were lower for certain subpopulations such as Black adults, adults who identified as “Some other race/Multiple races,” adults without a high school education, and adults without health insurance coverage. More resources, attention, or new strategies may be needed to close the gaps for these hardest-to-reach groups.

Asian and White adults continued to have above-average vaccination rates at 94.6% and 79.5%, respectively. Rates among Black adults (71.9%) and adults identifying with “Two or more” (Multiple) or “Some other” race (68.5%) continued to be below the national average. Rates among Hispanic/Latino adults improved, and are now above the national average at 79.6%. Hispanic/Latino adults also saw the largest improvement relative to the national average, going from almost 20 percent below the national average in late March (37.9% vs. 47.0%) to nearly one percent above the national average in June (79.6% vs. 79.1%).

Percent of Adults Who Had Received a COVID-19 Vaccine by Race/Ethnicity, 2021

Disparities by education level remained, with adults holding a bachelor’s degree or higher continuing to have the highest vaccination rate at 90.8%, and adults without a high school diploma having the lowest vaccination rate at 68.6%. Despite having the lowest vaccination rate, adults without a high school diploma had the largest relative improvement to the national average, going from 38 percent below the national average in March (29.2% vs. 47.0%) to 13 percent below the national average in June (68.6% vs. 79.1%). Vaccination rates among adults with a high school degree or equivalent and adults with some college or an associate’s degree also improved somewhat relative to the national average.

Adults with health insurance coverage had an above-average vaccination rate at 82.4%, while uninsured adults had a below-average vaccination rate at 61.4%. Regardless of having a rate substantially below the average, the rate among those not covered by any type of health insurance had a notable improvement relative to the national average, going from 50 percent below the national average in March (23.7% vs. 47.0%) to 22 percent below the national average in June (61.4% vs. 79.1%).

Percent of Adults Who Had Received a COVID-19 Vaccine by Education and Health Insurance Status, 2021

Notes about the Household Pulse Survey Data
The estimated rates presented in this post were pulled from the HPS COVID-19 Vaccination Tracker published by the Census Bureau. Though these counts are accompanied by standard errors, standard errors are not able to be accurately calculated for rate estimates. Therefore, we are not able to determine if the differences we found in our analysis are statistically significant or if the estimates themselves are statistically reliable. Estimates and differences for subpopulations at the state level should be assumed to have large confidence intervals around them and caution should be taken when drawing strong conclusions from this analysis. However, the fact that these indications of COVID-19 inequities mirror patterns of other vaccinations inequities demonstrate reason for concern.

Though produced by the U.S. Census Bureau, the HPS is considered an “experimental” survey and does not necessarily meet the Census Bureau’s high standards for data quality and statistical reliability. For example, the survey has relatively low response rates (6.4% for June 9-21), and sampled individuals are contacted via email and text message, asking them to complete an internet-based survey. These issues in particular could be potential sources of bias, but come with the tradeoffs of increased speed and flexibility in data collection as well as lower costs. A future post will investigate differences between COVID-19 vaccination rates estimated from survey data (such as the HPS) and administrative sources. The estimates presented this post are based on responses from 68,067 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.

Previous Blogs in the Series
COVID-19 Vaccination Rates: State-level and Subpopulation Analysis of the Household Pulse Survey (Update 5: March 17 to March 29) (SHADAC Blog)
COVID-19 Vaccination Rates: State-level and Subpopulation Analysis of the Household Pulse Survey (Update 4: March 3 to March 15) (SHADAC Blog)  
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 3: Feb 17 to March 1) (SHADAC Blog)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 2: Feb 3 to Feb 15) (SHADAC Blog)
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update: Jan 10 to Feb 1) (SHADAC Blog)
COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (Jan 6 to Jan 18) (SHADAC Blog)

Related Reading
Vaccine Hesitancy Decreased During the First Three Months of the Year: New Evidence from the Household Pulse Survey (SHADAC Blog)
State-level Flu Vaccination Rates among Key Population Subgroups (50-state profiles) (SHADAC Infographics)
50-State Infographics: A State-level Look at Flu Vaccination Rates among Key Population Subgroups (SHADAC Blog)
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
New Brief Examines Flu Vaccine Patterns as a Proxy for COVID – Anticipating and Addressing Coronavirus Vaccination Campaign Challenges at the National and State Level (SHADAC Blog)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)
SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4th) (SHADAC Webinar)

Planalp, Colin
Research Fellow

p 612-624-4850
e cplanalp@umn.edu

Vaccinating children may be key to reaching COVID-19 herd immunity

Few states could hit 80% vaccination rate until children are eligible

As more people become vaccinated against COVID-19, it’s understandable that many want to return to “normal.” Recognizing that desire, the U.S. Centers for Disease Control and Prevention (CDC) recently published guidance on activities people can engage in after being fully vaccinated; for instance, those who are fully vaccinated may socialize indoors, without a mask, with other fully vaccinated people.¹

However, as the U.S. still works toward a goal of “herd immunity,” in which a sufficient share of the population has been vaccinated to stem the spread of the virus, the CDC also recommends that everyone—including fully vaccinated individuals—continue to take precautions. For example, people should continue to wear masks and social distance in public, avoid large gatherings, and postpone travel plans until enough people are vaccinated.

While the herd immunity threshold to halt community spread of COVID-19 is yet unknown, experts such as Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, estimate the rate is somewhere between 70-90 percent of the population. The development and authorization of multiple vaccines raises hope for achieving herd immunity, but reaching that goal will be neither fast nor easy.

One major challenge on the path toward herd immunity is that current vaccines are primarily or entirely limited to adults. However, children make up a substantial share of the U.S. population—roughly 22 percent for the country overall, and ranging by state from a low of 18 percent in Vermont to a high of 29 percent in Utah.

State-level population data illustrate the impracticality of reaching herd immunity thresholds until COVID immunization is also broadly available for children. For instance, assuming a 70 percent threshold for COVID, which falls on the lower end of what experts predict, herd immunity would be challenging for most states and almost impossible for others.

Estimated Percentage of State Adult Populations Needed to Reach Total Population Herd Immunity

To reach 70 percent of the overall state population by immunizing only adults, Vermont would have to vaccinate 86 percent of the state’s adult population, while Utah would have to vaccinate 99 percent of its adult population. Achieving those goals would necessitate concerted efforts to overcome historic disparities in distribution of vaccines, as well as nascent inequities in the distribution of COVID vaccines, as SHADAC has documented in other analyses.^2,3,4

As herd immunity targets increase—from 70 percent to 80 percent to 90 percent—reaching herd immunity through only adults ultimately becomes mathematically impossible for all states due to their sizeable numbers of children, who are largely ineligible for vaccination as of yet.

Eventually, as COVID vaccine trials are completed and the immunizations are approved for children, herd immunity will become a tangible and achievable landmark. The U.S. has decades of experience in successfully immunizing its population against communicable diseases. For example, recent estimates from the CDC show that more than 90 percent of eligible children have received vaccines against chickenpox; hepatitis B; polio; and measles, mumps and rubella.⁵

But until COVID vaccines have been deeply distributed among both adults and children, it will likely remain important for people to take continued public health precautions such as social distancing and wearing face masks to slow the spread of the virus, as recommended by the CDC.

Related Reading
Measuring Coronavirus Impacts with the Census Bureau's New Household Pulse Survey: Utilizing the Data and Understanding the Methodology (SHADAC Blog Series)
State-level Flu Vaccination Rates among Key Population Subgroups (50-state profiles) (SHADAC Infographics)
50-State Infographics: A State-level Look at Flu Vaccination Rates among Key Population Subgroups (SHADAC Blog)
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update 2: Feb 3 to Feb 15)

Newly available COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. The pace of the COVID-19 vaccination rollout in the United States has been somewhat erratic—with reports of slow early going before picking up somewhat in following weeks, only to be hampered by recent storms across the southern region. However, signs of vaccination progress are appearing on the horizon once again, with manufacturers ramping up production, shipping getting back on track after the recent roadblocks, and early positive news from the FDA regarding Johnson & Johnson’s single-shot vaccine. The initial groups prioritized for vaccination were health care workers on the front lines of the pandemic and nursing facility residents, many of whom are especially vulnerable to COVID-19 infection and severe outcomes.

While these groups continue to hold priority in vaccination slots, many states have expanded vaccine access to other (still high-priority) segments of the general population such as older adults, K-12 and child care workers, essential workers, and those with high-risk medical conditions. However, there are concerns that these prioritization decisions and the existing mechanisms of the vaccine rollout—in addition to evidence that lower-income individuals, people of color, and individuals without strong connections to the health care system are less likely to get vaccinated—are inadequate to narrow the clear disparities in the vaccine rollout so far and could worsen existing pandemic-related health inequities.

The available data have not assuaged these concerns, and show patterns of lower vaccination rates among people with lower incomes and levels of education, and marginalized racial and ethnic groups. The U.S. Census Bureau recently released updated data on take-up of COVID-19 vaccines from the most recent wave of its Household Pulse Survey (HPS), collected February 3-15, 2021.¹ The HPS is an ongoing, weekly tracking survey designed to measure impacts of the COVID-19 pandemic. These data provide an updated snapshot of COVID-19 vaccination rates and are the only data source to do so at the state level by subpopulation. This blog post presents top-level findings from these new data, focusing on rates of vaccination (one or more doses) among U.S. adults (age 18 and older) living in households and comparing to results from the most recent wave of the HPS, collected January 20-February 1, 2021.²

Nearly one in five adults had received a vaccination, but this varied by state
According to the new HPS data, 19.9% of U.S. adults had received one or more COVID-19 vaccinations during this two-week period in the first half of February, though this varied by state from a low of 16.3% in the District of Columbia (D.C.) to a high of 31.9% in Alaska. More than one in four adults had received a vaccine in three states: Alaska, Hawaii, and New Mexico.

Vaccination rates increased substantially across nearly all states; states with lower rates catching up
Nationally, adult vaccination rates were up from the previous wave of the HPS, increasing from 13.2% during January 20-February 1, 2021, to 19.9% during February 3-15, 2021. Most states also experienced increases in their vaccination rates, though again the size of these increases varied across the states, from an increase of 1.5 percentage points (PP) in Vermont to an increase of 10.9 PP in Wisconsin.

Percent of Adults Who Had Received a COVID-19 Vaccine

States that had previously had below-average vaccination rates caught up somewhat to the higher-performing states. The states that were below the national average in late January, such as California and Wisconsin, saw larger increases in their vaccination rates compared with the states that were above the national average in late January, so that by the middle of February, vaccination rates were somewhat more even across the states, with most states hovering just above or below 20% of their adult populations vaccinated.

Disparities in vaccination rates remain largely unchanged
COVID vaccination rates continued to vary to a great degree by demographic and socioeconomic factors, though disparities narrowed slightly from previous weeks. This narrowing could be due to the expansion of priority groups to include a broader share of the population over this period; however, progress has remained limited in getting vaccines to certain groups such as low-income, Hispanic, and Black adults, for instance, and new vaccination strategies may be needed to reach the hardest-to-reach groups such as these.

By race and ethnicity, non-Hispanic Asian and non-Hispanic White adults continued to have above-average vaccination rates at 25.3% and 21.5%, respectively. Vaccination rates among non-Hispanic adults identifying with “Multiple” races or “Some other” race, which had previously increased relative to the average, fell behind pace and rose to just 16.3%, below the national average of 19.9%. Rates among non-Hispanic Black adults (16.2%) and Hispanic/Latino adults of any race (15.0%) remained below the national average.

Percent of Adults Who Had Received a COVID-19 Vaccine by Race/Ethnicity

Disparities in vaccination rates by income continued to narrow, though rates among those with the lowest incomes remained far below the average. Adults with household incomes of less than $25,000 were nearly half as likely to have received a vaccine compared with all adults (10.7% vs. 19.9%). This gap was largely unchanged from previous weeks, even as the gap between other lower-income groups and the average steadily narrowed from early January.

Percent of Adults Who Had Received a COVID-19 Vaccine by Income

Disparities by level of education remained, with adults holding a bachelor’s degree or higher continued to have the highest vaccination rate at 28.2%, and adults without a high school diploma having the lowest vaccination rates at 12.2%. However, disparities by education did narrow somewhat, and vaccination rates among both adults with a high school diploma or equivalent and adults with less than a high school education increased faster than the overall adult rate.

Percent of Adults Who Had Received a COVID-19 Vaccine by Education

Nearly 2 in 5 older adults received a COVID vaccine as the U.S., and many states, continued to make large progress in vaccinating older adults
Nationally, 38.5% of older adults (age 65 and older) had received at least one dose of the COVID-19 vaccine, which was 18.6 percentage points higher than the rate among all adults (19.9%). Vaccination rates for older adults ranged from 17.6% in Rhode Island to 60.5% in Alaska. Older adult vaccination rates were below 25% in four states (New Hampshire, Oregon, Rhode Island, and Vermont) and at or above 50% in five states (Alaska, Georgia, Indiana, Mississippi, and Oklahoma) and in D.C.

Percent of Adults Age 65+ Who Had Received a COVID-19 Vaccine

As in the previous period, states continued to make large progress in rates of vaccination among older adults. Compared to the end of January, 19 states more than doubled their 65+ vaccination rates, and three states (Minnesota, Wisconsin, and Nebraska) more than tripled their 65+ vaccination rates, with Minnesota nearly quadrupling its rate (from 8.5% to 33.7%). Only a handful of states failed to make substantial progress in increasing vaccination rates among older adults.

Notes about the Household Pulse Survey Data
The estimated rates presented in this post were calculated from the count estimates published by the Census Bureau. Though these counts are accompanied by standard errors, standard errors are not able to be accurately calculated for rate estimates. Therefore, we are not able to determine if the differences we found in our analysis are statistically significant or if the estimates themselves are statistically reliable. Estimates and differences for subpopulations at the state level should be assumed to have large confidence intervals around them and caution should be taken when drawing strong conclusions from this analysis. However, the fact that patterns of inequities in other vaccination rates are mirrored by these early indications of COVID-19 vaccination inequities demonstrates reason for concern.

Though produced by the U.S. Census Bureau, the HPS is considered an “experimental” survey and does not necessarily meet the Census’s high standards for data quality and statistical reliability. For example, the survey has relatively low response rates (7.3% for February 3-15), and sampled individuals are contacted via email and text message, asking them to complete an internet-based survey. These issues in particular could be potential sources of bias, but come with the tradeoffs of increased speed and flexibility in data collection as well as lower costs. A future post will investigate differences between COVID vaccination rates estimated from survey data (such as the HPS) and administrative sources. The estimates presented this post are based on responses from 77,122 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.

Previous Blogs in the Series

COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (Update: Jan 10 to Feb 1)
COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (Jan 6 to Jan 18)

Related Reading
State-level Flu Vaccination Rates among Key Population Subgroups (50-state profiles) (SHADAC Infographics)
50-State Infographics: A State-level Look at Flu Vaccination Rates among Key Population Subgroups (SHADAC Blog)
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
New Brief Examines Flu Vaccine Patterns as a Proxy for COVID – Anticipating and Addressing Coronavirus Vaccination Campaign Challenges at the National and State Level (SHADAC Blog)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)
SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4th) (SHADAC Webinar)

SHADAC Staff

p 612.624.4802
e shadac@umn.edu

COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (Jan 6 to Jan 18)

Newly available COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. However, the rollout of the COVID-19 vaccines thus far—largely delegated to the states—has been slow and inconsistent. The initial groups prioritized for vaccination were health care workers on the front lines of the pandemic and nursing facility residents, many of whom are especially vulnerable to COVID-19 infection and severe outcomes. However, there are concerns that these prioritization decisions—in addition to evidence that lower-income individuals, people of color, and individuals without strong connections to the health care system are less likely to get vaccinated—could worsen existing pandemic-related health inequities.

Preliminary data have unfortunately reinforced these concerns, showing patterns of lower vaccination rates among people with lower incomes and levels of education, and marginalized racial and ethnic groups. The U.S. Census Bureau recently released new data on take-up of COVID-19 vaccines from the most recent wave of its Household Pulse Survey (HPS), collected January 6-18, 2021. The HPS is an ongoing, weekly tracking survey designed to measure impacts of the COVID-19 pandemic. These data are the first to provide estimates of COVID-19 vaccination rates at the state level and by subpopulation. This blog post presents top-level findings from these new data, focusing on rates of vaccination (one or more doses) among U.S. adults (age 18 and older) living in a household unit.1

Roughly eight percent of adults had received a vaccination, but this varies by state
According to the new HPS data, 7.7% of U.S. adults had received one or more COVID-19 vaccinations during this two week period in January, though this varied by state from a low of 5.4% in California to a high of 13.7% in Hawaii. More than one in ten adults had received a vaccine in nine states: Alaska, Hawaii, Montana, New Mexico, North Dakota, Oklahoma, South Dakota, Texas, and Vermont.


Disparities in vaccination rates reflect concerns about harder-to-reach groups and groups prioritized for initial round of vaccinations
Vaccination rates also varied substantially by a number of demographic and socioeconomic factors. These could be partly a result of decisions to prioritize health care workers, who tend to be less racially and ethnically diverse than the overall population, and who often have higher incomes and levels of education.

By race and ethnicity, non-Hispanic Asian adults had the highest vaccination rates at 13.1%, followed by non-Hispanic White adults at 8.0%. Hispanic/Latino adults (any race), non-Hispanic Black adults, and non-Hispanic adults identifying with multiple races or some other race had lower vaccination rates (5.8%, 5.8%, and 6.2%, respectively). A similar pattern was seen across many states, with Asian and White adults often more likely to have received a vaccine than Black and Hispanic adults.

Large disparities in vaccination rates by income were also apparent, with the highest income groups reporting higher rates of vaccination compared to those with lower incomes, and rates increasing steadily in correlation with income. Of adults with household incomes of $100,000 or higher, 12.0% had received a COVID-19 vaccine, which was nearly 2.5x higher than the rate among those with incomes below $25,000.

Nearly half of all adults who had received a COVID-19 vaccine have incomes of at least $100,000, despite making up only three in ten adults in the overall population.

Similar patterns by income were seen across the states. For example, in 17 states, adults in the highest income category were at least 5x more likely to have been vaccinated than those in the lowest income category.

Patterns of vaccination by education were similar to those by income, with adults with less education being less likely to have received a vaccine compared to adults with more education. Nationally, 12.2% of adults with a bachelor’s degree or higher have received a vaccine compared with 3.7% of adults with less than a high school education.

More progress is needed in vaccinating the older adult population most vulnerable to severe COVID-19 morbidity and mortality
Nationally, older adults (age 65 older) were no more likely to have received a COVID-19 vaccine than the overall adult population. During the period of January 6 through January 18, 7.1% of older adults had received a vaccine compared with 7.7% of all adults. This may be of concern because older adults are more likely to develop severe COVID-19 cases or die from the disease compared to the general population. Consequently, many states have given precedence to vaccinations for older adults, but these early data don’t show that prioritization is resulting in higher vaccination rates.
Vaccination rates for older adults ranged from 1.7% in Nevada to 21.9% in Alaska. Vaccination rates were below five percent in 15 states and were above ten percent in seven states. Older adults were more likely to have received a vaccine than the overall population in just 11 states

Notes about the Household Pulse Survey Data
Many of the estimates published by the Census Bureau and presented here were not accompanied by standard errors. Therefore, we are not able to determine if the differences we found in our analysis are statistically significant or if the estimates themselves are statistically reliable. Estimates and differences should be assumed to have large confidence intervals around them—especially for subpopulations at the state level—and caution should be taken when drawing strong conclusions from this analysis. However, the fact that patterns of inequities in other vaccination rates are mirrored by these early indications of COVID-19 vaccination inequities demonstrates reason for concern.

Though produced by the U.S. Census Bureau, the HPS is considered an “experimental” survey and does not necessarily meet the Census’s high standards for data quality and statistical reliability. For example, the survey has relatively low response rates (6.5% for January 6–18) and sampled individuals are contacted via email and text message, asking them to complete an internet-based survey. These issues in particular could be potential sources of bias, but come with the tradeoffs of increased speed and flexibility in data collection as well as lower costs. The estimates presented this post are based on responses from 68,348 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.

Related Reading
Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (SHADAC Brief)
New Brief Examines Flu Vaccine Patterns as a Proxy for COVID – Anticipating and Addressing Coronavirus Vaccination Campaign Challenges at the National and State Level (SHADAC Blog)
Ensuring Equity: State Strategies for Monitoring COVID-19 Vaccination Rates by Race and Other Priority Populations (Expert Perspective for State Health & Value Strategies)
Upcoming SHADAC Webinar - Anticipating COVID-19 Vaccination Challenges through Flu Vaccination Patterns (February 4th) (SHADAC Webinar)