Health Care Access and COVID-19 Vaccination in the United States

Background: Although federal legislation made COVID-19 vaccines free, inequities in access to medical care may affect vaccine uptake. Objective: To assess whether health care access was associated with uptake and timeliness of COVID-19 vaccination in the United States. Design: A cross-sectional study. Setting: 2021 National Health Interview Survey (Q2-Q4). Subjects: In all, 21,532 adults aged≥18 were included in the study. Measures: Exposures included 4 metrics of health care access: health insurance, having an established place for medical care, having a physician visit within the past year, and medical care affordability. Outcomes included receipt of 1 or more COVID-19 vaccines and receipt of a first vaccine within 6 months of vaccine availability. We examined the association between each health care access metric and outcome using logistic regression, unadjusted and adjusted for demographic, geographic, and socioeconomic covariates. Results: In unadjusted analyses, each metric of health care access was associated with the uptake of COVID-19 vaccination and (among those vaccinated) early vaccination. In adjusted analyses, having health coverage (adjusted odds ratio AOR 1.60; 95% CI: 1.39, 1.84), a usual place of care (AOR 1.58; 95% CI: 1.42, 1.75), and a doctor visit within the past year (AOR 1.45, 95% CI: 1.31, 1.62) remained associated with higher rates of COVID-19 vaccination. Only having a usual place of care was associated with early vaccine uptake in adjusted analyses. Limitations: Receipt of COVID-19 vaccination was self-reported. Conclusions: Several metrics of health care access are associated with the uptake of COVID-19 vaccines. Policies that achieve universal coverage, and facilitate long-term relationships with trusted providers, may be an important component of pandemic responses.