Blog & News
COVID-19 Vaccination Rates: State-level and Subpopulation Evidence from the Household Pulse Survey (Update: Jan 20 to Feb 1)
February 11th, 2021:Newly available COVID-19 vaccines promise to help protect individual Americans against infection and eventually provide population-level herd immunity. However, while the pace of COVID-19 vaccinations has picked up somewhat in recent weeks, the overall rollout thus far has remained somewhat 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.
While these groups continue to hold priority in vaccination slots, in response to reports of vaccines lingering unused and criticism from the public that limitations on vaccinations have too far slowed progress toward herd immunity many states have also recently begun expanding vaccine access to other (still high-priority) segments of the general population such as older adults, K-12 and child care 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—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 January 20-February 1, 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 previous wave of the HPS, collected January 6-18.2
Roughly 13 percent of adults received a vaccination, but this varied by state
According to the new HPS data, 13.2% of U.S. adults had received one or more COVID-19 vaccinations during this two week period in January through February, though this varied by state from a low of 8.6% in Alabama to a high of 23.2% in Hawaii and Alaska. More than one in six adults had received a vaccine in eight states: Alaska, Hawaii, Indiana, Mississippi, New Mexico, Oklahoma, South Dakota, and West Virginia.
Vaccination rates increased substantially across nearly all states
Nationally, adult vaccination rates were up from the previous wave of the HPS, increasing from 7.7% in January 6-18 to 13.2% in January 20-February 1. Most states also experienced increases in their vaccination rates, though again the size of these increases varied across the states, from an increase of just 0.5 percentage points (PP) in Montana to an increase of 10.5 PP in Mississippi. Vaccination rates more than doubled in eight states: California, Florida, Indiana, Mississippi, Nevada, New York, South Carolina, and West Virginia.
Percent of Adults Who Had Received a COVID-19 Vaccine
Disparities in vaccination rates remain, though some have narrowed
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 and Hispanic 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 19.5% and 14.0%, respectively. Vaccination rates among non-Hispanic adults identifying with multiple races or “some other” race increased relative to the average, rising to 13.1%, nearly in line with the national average of 13.2%. Rates among non-Hispanic Black adults (11.0%) and Hispanic/Latino adults of any race (9.4%) remained below the national average.
Percent of Adults Who Had Received a COVID-19 Vaccine by Race/Ethnicity
Disparities in vaccination rates by income narrowed somewhat, though those with the highest incomes continued to be much more likely to have received a vaccine compared with those with lower levels of income. Of adults with incomes of $100,000 or more, 18.0% had received a vaccination compared to just 6.6% of those with incomes less than $25,000. This pattern was broadly consistent across the states, and in nearly all states, adults with incomes of $100,000 or greater were more likely to have received a vaccine than the state overall.
Percent of Adults who Received a COVID-19 Vaccine by Income
Disparities by level of education did not appreciably narrow, with adults holding a bachelor’s degree or higher having the highest vaccination rate at 20.2% and adults without a high school diploma having the lowest vaccination rates at 6.2%. These rates remained stable in relation to the national average compared with earlier in the month, and similar disparities were common across nearly all states.
At least 1 in 5 older adults received a COVID vaccine as the U.S. and many states made large progress in vaccinating older adults
Nationally, 20.4% of older adults (age 65 and older) had received at least one dose of the COVID-19 vaccine, which was more than seven percentage-points higher than among all adults (13.2%). Vaccination rates for older adults range from 8.5% in Minnesota to 56.0% in Alaska. Older adult vaccination rates were below 10% in three states (Kansas, Nebraska, and Minnesota) and above 30% in nine states (Alaska, Colorado, Florida, Georgia, Indiana, Louisiana, Mississippi, North Carolina, and Oklahoma) and the District of Columbia (D.C.).
The U.S. and nearly all states made large progress in vaccinating older adults compared with earlier in the month when older adults were no more likely to have received a vaccine than adults overall. This change was likely a reflection of many states’ recent expansion of vaccine prioritization for the general older-adult population and is heartening, considering that older adults are more likely to develop severe COVID-19 cases or die from the disease as compared to the general population.
Most states saw large increases in rates of vaccination among older adults, though from a relatively low baseline. Compared to earlier in January, 43 states and D.C. more than doubled their 65+ vaccination rates, with 26 of those at least tripling their rates. Only Minnesota failed to make substantial progress, increasing its older-adult vaccination rate to just 8.5% from 8.2% earlier in January, an increase of less than a percentage point.
Percent of Adults Age 65+ Who Had Received a COVID-19 Vaccine
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 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 (7.5% for January 20-February 1), 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 in this post are based on responses from 80,567 adults. More information about the data and methods for the Household Pulse Survey can be found in a previous SHADAC blog post.
Related Reading
COVID-19 Vaccination Rates: New State-level and Subpopulation Evidence from the Household Pulse Survey (Jan 6 to Jan 18) (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)
Blog & News
Two New Changes to the Child Vaccinations Measure on SHADAC’s State Health Compare
December 10, 2020:SHADAC is making two modifications to its State Health Compare (SHC) Child Vaccinations measure in response to changes in how the data source for this measure (the National Immunization Survey-Child [NIS]) reports estimates. The NIS recently transitioned to reporting estimates by child birth year (e.g., the percent of children born in 2015 who had received the recommended vaccines). Previously, the estimates had been reported by survey year (e.g., the percent of children surveyed in 2015 who received the recommended vaccines). Announcement of this change was included in a recent CDC Morbidity and Mortality Weekly Report where the authors noted that “the transition to reporting by birth year rather than by survey year more directly assesses recent changes in vaccination coverage and provides more interpretable estimates and more accurate comparisons to evaluate immunization information systems.”[1]
As a consequence, SHADAC is now reporting its Child Vaccinations measure by child birth year (from 2011-2016) rather than by survey year. SHADAC has also altered the measure definition to be the “percent of children age 24 months who had received all recommended vaccines,” changed from the “percent of children age 19-35 months who had received all recommended vaccines.” This change is consistent with the new way these estimates are reported from the NIS, and with the Centers for Disease Control’s (CDC) recommended vaccine schedule. Previous estimates from survey years 2000-2017 will no longer be available on State Health Compare but continue to be available through CDC’s ChildVaxView and from SHADAC upon request.
As before, Child Vaccinations measures the rate of receipt of recommended vaccinations, which is defined as getting the recommended doses of the 7-vaccine series.[2] The CDC’s child and adolescent vaccination schedule recommends children to have received these vaccines by the age of 18 months. SHC’s Child Vaccinations measure reports the rate of receipt at 24 months of age.
Visit SHADAC's State Health Compare to further explore the new Child Vaccinations measure.
[1] Hill, H.A., Singleton, J.A., Yankey, D., Elam-Evans, L.D., Pingali, S.C., & Kang, Y. Vaccination coverage by age 24 months among children born in 2015 and 2016—National Immunization Survey-Child, United States, 2016-2018. MMWR, 68(41), 913-918.
[2] The combined 7-vaccine series consists of 4 or more doses of either the diphtheria, tetanus toxoids, and pertussis vaccine (DTP), the diphtheria and tetanus toxoids vaccine (DT), or the diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP); 3 or more doses of any poliovirus vaccine; 1 or more doses of a measles containing vaccine (MCV); 3 or more doses or 4 or more doses of Haemophilus influenzae type b vaccine (Hib) depending on Hib vaccine product type (full series Hib); 3 or more doses of hepatitis B vaccine; 1 or more doses of varicella vaccine; and 4 or more doses of pneumococcal conjugate vaccine (PCV).
Blog & News
November 10th Webinar - "Overdose Crisis in Transition: Changing Trends in a Widening Drug Death Epidemic"
August 01, 2024:
Mr. Planalp was joined by SHADAC Research Fellow Robert Hest, who explained how to access and use the data on opioid-related overdose deaths and sales of opioid painkillers through SHADAC’s State Health Compare website. Slides from the presentation, as well as a list of further SHADAC resources regarding the opioid crisis can be found at the bottom of this page.
Speakers
Colin Planalp, MPA
SHADAC Senior Research Fellow
Robert Hest, MPP
SHADAC Research Fellow
Event Resources
The Opioid Epidemic (SHADAC Resource Page)
Overdose Crisis in Transition: Changing National and State Trends in a Widening Drug Death Epidemic (Briefs)
50-State Analysis of Drug Overdose Trends: The Evolving Opioid Crisis Across the States (Infographics)
After drop in 2018, newer data indicate a resurgence in drug overdose deaths
Blog & News
October 21st Webinar - Rising Suicide Rates: Examining Trends and Variations through State-level Data
August 01, 2024:Over the past two decades, the rise in suicide death rates has continued along an accelerating climb. According to new vital statistics data from the Centers for Disease Control and Prevention (CDC), the United States suicide rate reached another historic high of 14.2 per 100,000 people in 2018, up from 14.0 in the previous year.
This increase in suicide deaths has not followed a consistent trend; rather, growth has accelerated more recently. From 2000 to 2009 the suicide death rate grew by 13 percent, but from 2009 to 2018 the rate grew by 21 percent. While these trends predate the COVID-19 pandemic, early evidence has indicated this crisis is taking a significant toll on mental health, and these data therefore represent an important baseline from which the effects of the pandemic will be measured.
During the webinar, SHADAC Research Fellow Carrie Au-Yeung used national and state-level data on suicide deaths to examine this growing public health issue, highlighting concerning trends and variations in suicide deaths by geographic locations such as regions, states, and metropolitan areas, as well as by specific subpopulation groups such as age, sex, and race/ethnicity.
Ms. Au-Yeung was also joined by SHADAC Research Fellow Robert Hest, who explained how to access and use the data on suicide deaths through SHADAC’s State Health Compare website. Senior Research Fellow Colin Planalp also joined the webinar for a question and discussion session following the presentation.
Related Resources
Suicide Rates on the Rise: Examining Continuing Trends and Variation across the Nation and in the States from 2000 to 2018 (Briefs)
U.S. Suicide Death Rate Reached Record High in 2018: SHADAC Briefs Examine the Numbers among Subgroups and States
State Health Compare Data Offer Baseline for Measuring Pandemic's Impact on Suicide, Drug Overdose Death Rates
National Suicide Prevention Lifeline: 1-800-273-8255
If you’re thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. For more suicide prevention resources, visit https://suicidepreventionlifeline.org/
Publication
Comparing Federal Government Surveys That Count the Uninsured: 2020
With the release of new insurance coverage estimates from surveys conducted by the U.S. Census Bureau, the Agency for Healthcare Research and Quality (AHRQ), and the Centers for Disease Control and Prevention (CDC), SHADAC has updated our annual “Comparing Federal Government Surveys that Count the Uninsured” brief.
The brief provides an annual update to comparisons of uninsurance estimates from four federal surveys:
- The American Community Survey (ACS)
- The Current Population Survey (CPS)
- The Medical Expenditure Panel Survey - Household Component (MEPS-HC)
- The National Health Interview Survey (NHIS)
In this brief, SHADAC presents current and historical national estimates of uninsurance along with the most recent available state-level estimates from these surveys. We also discuss the main reasons for variation in the estimates across the different surveys as well as possible reasons for incomparability of estimates across and within the surveys.
Download a PDF of the Comparing Federal Government Surveys Brief.
Last year’s brief with data from 2019, and certain 2018 data, can be accessed here.