Medical mistrust and vaccine-hesitant attitudes explain SARS-CoV-2 vaccination disparities in a mixed serostatus cohort
Year: 2024
Type: article
Abstract: OBJECTIVES: To understand the extent of racial disparities in SARS-CoV-2 vaccination among PWH and those vulnerable to HIV infection and to estimate the contributions of medical mistrust and vaccine-hesitant attitudes to these disparities. DESIGN: Quantitative data analyses in a racially and gender-diverse, mixed-serostatus prospective cohort, the Multicenter AIDS Cohort Study (MACS)/Women's Interagency HIV Study (WIHS) Combined Cohort Study. METHODS: Interviewer-assisted questionnaires assessed SARS-CoV-2 vaccination, medical mistrust, and vaccine-hesitant attitudes from March 2021 to September 2022 ( n = 3948). Longitudinal analyses assessed effects of sociodemographics on medical mistrust and vaccine-hesitant attitudes. A hierarchical multivariable logistic regression assessed effects of these co-factors on SARS-CoV-2 vaccination. Causal mediation models assessed whether medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, and vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 nonvaccination. RESULTS: Participants' mean age was 56.7; 55.3% were Black, 52.6% cisgender female, 62.6% PWH. 10.1% reported never receiving SARS-CoV-2 vaccinations (13.4% of Black and 4.5% of White participants). Black-identified participants had higher odds of nonvaccination than White participants [aOR = 1.72; 95% confidence interval (CI) 1.08-2.72]. Medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, accounting for 46% of the effect ( P < 0.0001). Vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 nonvaccination to the extent that 57.7% (95% CI 25.3-90.1%) of the disparity would be eliminated if vaccine-hesitant attitudes among Black respondents were reduced to levels reported among other racial groups. CONCLUSION: Findings indicate a profound need to build trustworthy healthcare environments to combat medical mistrust and vaccine-hesitant attitudes in Black communities in the United States, including those affected by HIV.
Source: AIDS
Authors: M. Reuel Friedman, Gina Wingood, Kristen D. Krause, Sarah Krier, Gypsyamber D'Souza, Mirjam-Colette Kempf, Matthew J. Mimiaga, Jenn Kwait, Deborah L. Jones, Jeremy Martinson, Ernesto T. Marques, Phyllis Tien, Kathryn Anastos, Catalina Ramirez, Mardge Cohen, Marlene Camacho-Rivera, Lakshmi Goparaju, Charles R. Rinaldo
Institutions: Rutgers, The State University of New Jersey, University of Pittsburgh, Columbia University, Johns Hopkins University, University of Alabama at Birmingham, University of California, Los Angeles, Whitman-Walker Health, University of Miami, University of California, San Francisco, Albert Einstein College of Medicine, University of North Carolina at Chapel Hill, John H. Stroger, Jr. Hospital of Cook County, SUNY Downstate Health Sciences University, Georgetown University
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
Funders: Georgia Clinical and Translational Science Alliance, National Institutes of Health, University of California, San Francisco, Center for AIDS Research, University of Alabama at Birmingham, National Institute on Alcohol Abuse and Alcoholism, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Dental and Craniofacial Research, National Center for Advancing Translational Sciences, National Institute on Minority Health and Health Disparities, Center for AIDS Research, University of North Carolina at Chapel Hill, Clinical and Translational Science Institute, University of California, Los Angeles
Awards: G1034546755, G12089860, G1296759572, G1400602301, G1655989834, G1773452051, G1787625665, G183157880, G1849940085, G1913134163, G192128497, G1972383081, G2008237588, G2127051194, G248584506, G255204022, G2755707676, G2759654445, G2839061624, G2908277772, G30074556, G311558797, G319781266, G3242306066, G3418878615, G343705321, G3630727822, G3671922257, G3869857964, G3924589403, G4016133911, G4044828089, G4391827178, G4535678174, G456742281, G483408255, G5078796989, G521591464, G5431849782, G5691055145, G5747858550, G5900455136, G6745172908, G693265041, G6990385686, G775892330, G7760075911, G7807729167, Johns Hopkins Institute for Clinical and Translational Research, G9000016284, G9000030090, G9000030772, G9000031392, G9000039899, G9000041916, G9000080293, G9000082816, G9000102070, G9000108991, G9000146713, University of Pittsburgh MACS/WIHS CCS, MACS/WIHS -CCS, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Data Analysis and Coordination Center for the MACS-WIHS Combined Cohort Study, MACS/WIHS Combined Cohort Study: Brooklyn Clinical Research Site (Bklyn CRS), Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) - Baltimore/Wash DC Center, UAB-MISS MACS/WIHS Combined Cohort Study, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR)
OpenAlex ID: W4404080008