Disparities Persist Among US Adults Receiving a COVID-19 Booster Vaccine


Researchers suggest that more public health measures should be taken to address disparities among adults boosted for COVID-19.

A new study published in JAMA Network Open shows disparities among boosted adults in the United States dependent on geographic, occupational, and sociodemographic variations, suggesting targeted efforts to increase boosted subgroups. Populations with low socioeconomic status, those previously affected by COVID-19, and health beliefs could inhibit certain groups of people from getting boosted.

“Mass vaccination campaigns that incentivize people to receive and publicize their booster vaccinations may cue similar action among individuals in similar social networks according to research,” the study authors wrote.

From December 2020 to February 2021, the FDA issued emergency use authorizations for 3 vaccines—Ad26.COV2.S (Johnson & Johnson–Janssen), mRNA-1273 (Moderna), and BNT162b2 (Pfizer-BioNTech). Since then, more than 550 million COVID-19 vaccines have been administered in the United States.

Looking at current CDC data, investigators found no representative study evaluating the factors associated with receiving a booster. They aimed to conduct a cross-sectional survey to determine the impact of geographic, occupational, and sociodemographic factors on getting a COVID-19 booster among fully vaccinated adults in the United States.

Data were collected from the Household Pulse Survey—an online and probability-based survey that grouped estimated data on the national, state, and metropolitan level, and was conducted by the US Census Bureau.

Compiling results from 135,821 US adults, researchers surveyed 51% females and approximately 41% people aged 18 to 44 years. Statewide, an average of 48.5% of fully vaccinated adults received additional COVID-19 booster shots, signifying that less than half of vaccinated individuals were boosted.

Nationally, the non-Hispanic Asian population was most likely to get a booster, averaging 54.1%. Additionally, there were other populations with a proportionately higher percentage of vaccinations. These included adults aged 65 years and older (71.4%), those with an advanced degree (68.1%), individuals with Medicare (70.9%), and those with a household income at $200,000 or more (69.3%), among other factors.

“Within health care facilities nationwide, booster coverage was almost 25% higher among those working in hospitals compared with those working in a pharmacy, even with similar rates of initial vaccination completion,” the study authors wrote. “We found wide variations in booster coverage even among workers in the same industry.”

Conversely, only about 33% of individuals who previously contracted COVID-19, were enrolled in Medicaid, were in a pharmaceutical occupation, did not complete a high school education, or aged 18 to 24 years were boosted. Adults who worked in food or beverage stores or the agricultural, forestry, fishing, or hunting industries were less likely to be boosted.

The study was limited because surveys were self-reported and possibly biased. Additionally, the study can only infer, not conclude, any findings due to its cross-sectional nature. It also generalizes individuals outside the small sample and may be biased because of incorrect estimates of immunocompromised individuals, according to the authors.

“These findings suggest continuing disparities in receipt of booster vaccine doses among US adults. Targeted efforts at populations with low uptake may be needed to improve booster vaccine coverage in the US,” the study authors wrote.


Agaku, Israel, Adeoye, Caleb, Long, Theodore. Geographic, Occupational, and Sociodemographic Variations in Uptake of COVID-19 Booster Doses Among Fully Vaccinated US Adults, December 1, 2021, to January 10, 2022. JAMA Network Open. 2022;5(8): e2227680. doi:10.1001/jamanetworkopen.2022.27680

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