Younger age, tobacco use link to lower COVID-19 vaccination rates

Among patients with cirrhosis, younger age, active tobacco use, fewer medical comorbidities and residence in the southern United States correlated with decreased rates of COVID-19 vaccination.

“Since the start of the COVID-19 pandemic, roughly 700,000 Americans have lost their life to the virus; for patients with cirrhosis, we’ve seen higher rates of hospitalization, decompensation and death in the setting of COVID-19 infection. Luckily, the scientific community has been quick to respond and has developed multiple highly effective vaccines,” Sara Chapin, MD, a second-year internal medicine resident at the Hospital of the University of Pennsylvania, said. “Despite this, we have seen that vaccination rates within the United States remain less than ideal and as providers that are caring for this vulnerable patient population, it's our responsibility to improve access to this life saving resource.”

In a retrospective cohort study of data from the Veterans Health Administration, researchers analyzed 43,122 patients (median age, 67 years; 96% men; 61.3% white) with cirrhosis (hepatitis C virus, 31.1%; alcohol-related disease, 32.9%; nonalcoholic fatty liver, 31.8%) to help inform future vaccination efforts. They used multivariable logistic regression to identify variables linked to vaccination and generated predicted probabilities of vaccination. Patients underwent stratification by low (< 50%), medium (50-70%) and high probability (> 70%).

According to analysis, 60% of patients received either the Pfizer (49.2%), Moderna (46.9%) or Janssen (4.8%) COVID-19 vaccine. Compared with patients stratified by high probability to receive the COVID-19 vaccine, patients with low probability were more likely to be younger (median age 57 years vs. 72 years; P < .001), white (80.7% vs. 41.3%; P < .001), current smokers (49.9% vs. 11.8%; P < .001) and resided in southern U.S. regions (70.4% vs. 4.2%; P < .001). Researchers noted patients with low probability were less likely to have chronic comorbidities such as diabetes (24.2% vs. 76.1%; P < .001), coronary artery disease (7.7% vs. 47.4%; P < .001) or congestive heart failure (6.4% vs. 25.9%; P < .001).

“Getting at these regional differences in vaccination, it could potentially be explained by barriers to access to the vaccine or distribution in the rural areas as well as state differences in vaccine promotion. However, other potential contributing factors include vaccine hesitancy related to personal or political beliefs,” Chapin concluded. “Moving forward, I feel ultimately that it’s our duty as physicians caring for a vulnerable patient population to educate and encourage vaccination, but we also have to work to create new and innovative approaches to improve vaccination rates.”