Variation in COVID-19 vaccination and adverse outcomes: a state of Georgia case study

Background Differences in COVID-19 vaccine coverage, deaths, and hospitalizations across racial and ethnic groups have been documented in the United States. Evaluating these patterns at a smaller geographical scale while accounting for differences in vaccination uptake across racial groups provides additional insights. In this study, we quantify adult COVID-19 vaccination, death, and hospitalization outcomes across racial/ethnic groups and county urban-rural classification in the state of Georgia. Methods This cross-sectional study included adult COVID-19 vaccination (primary series, 1st booster, and 2nd booster), COVID-19-related deaths, and COVID-19-positive hospitalizations reported to the Georgia Department of Public Health through February 2023. We computed vaccination, death, and hospitalization rates for Hispanic, non-Hispanic (NH) Asian, NH Black, and NH White adults by county of residence urban-rural classification and vaccination status. Rate ratios (RRs) were calculated to evaluate differences in outcomes across racial/ethnic groups. Results There were 14,386,650 COVID-19 vaccine doses administered, 40,711 COVID-19-related deaths, and 138,024 hospitalizations recorded during the study period. Differences by race/ethnicity varied by outcome and county urban-rural class. NH Black adults were at higher risk of being hospitalized with COVID-19 than NH White adults (RR 1.77, 95% CI, 1.75–1.79), even when stratified by vaccination status. NH Black adults were at higher risk of dying of COVID-19 than NH White adults (RR, 1.37, 95% CI, 1.34–1.39), except among those who received a booster dose (RR, 0.96, 95% CI, 0.86–1.07). Conclusions NH Black adults experienced higher rates of adverse COVID-19-related outcomes compared to other racial/ethnic groups, even among the vaccinated. Stratifying outcomes by race/ethnicity, county urban-rural class, and vaccination status provided a better understanding of patterns across populations and geographies for targeted interventions. Public health agencies should focus on improving up-to-date vaccination coverage and removing barriers to access to care among communities that are underserved, particularly NH Black individuals.