Similar characteristics seen in patients with ESKD, public who question COVID-19 vaccine
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A national survey shows patients on dialysis who are hesitant about taking a vaccine for COVID-19 share similar characteristics to those in the general public with the same views, a speaker said.
Overall, however, a higher percentage of patients on dialysis are in favor of being vaccinated vs. in the general public, Pablo Garcia, MD, clinical research and nephrology fellow in the division of nephrology at Stanford University School of Medicine, said during a late-breaking session at the virtual National Kidney Foundation Spring Clinicals Meeting. “The highest hesitancy in the general population toward the COVID-19 vaccine is seen among Black adults who are aged 18 to 49 years old, have a lower income and did not complete a college degree,” Garcia said. “This group is similar to those receiving dialysis who are hesitant about taking the vaccine, based on our survey.”
Respondents categorized on the survey as of “American Indian and Asian-Pacific Islander descent” on dialysis also showed hesitancy about accepting the vaccine similar to those in the general public, Garcia, who is also a clinical scientist in nephrology for the American Kidney Fund, said.
Vaccine hesitation
A substantial fraction of individuals on dialysis belong to ethnic, socioeconomic, cultural and religious groups that are more likely to be vaccine hesitant, Garcia said. “In order to inform programs and policies aimed at promoting COVID-19 vaccine uptake in patients on hemodialysis, we offered a nationwide survey to persons undergoing in-center hemodialysis,” Garcia said. “Our objective was to estimate rates of vaccine hesitancy and describe the demographic and clinical characteristics of vaccine-hesitant persons and elicit their major concerns.”
Researchers canvassed 331 hemodialysis facilities with 30 or more patients managed by dialysis provider U.S. Renal Care. “These facilities were located throughout the U.S., and the population was representative of the overall U.S. dialysis population by age, sex and race/ethnicity,” Garcia said.
Researchers then randomly selected 150 facilities from the group using implicit stratification by region and ZIP code, “with the goal of reaching a representative sample of the U.S. Renal Care population,” Garcia said.
Patients were then asked in the survey about their views regarding vaccination. “For the purposes of the logistic regression analysis, we defined vaccine hesitancy as answering, ‘not sure,’ ‘probably not’ or ‘definitely not’ to any of the four COVID-19 vaccine-related questions,” Garcia said.
According to the survey results, the highest percentage of patients on dialysis who were hesitant or said they would refuse to take the vaccine were aged 18 to 44 years old. Garcia said this was consistently the case regardless of how survey questions were presented. When the statement was posed, “I would accept a vaccine if it was recommended and provided by my dialysis facility and proved safe and effective by the government,” 25% of patients on dialysis aged 18 to 44 years old in the survey group indicated they would probably not, definitely not or were not sure about accepting the vaccine – the highest percentage among the four age groups studied.
Among all patients in the study group who responded to that statement, regardless of age, 26% of Black individuals indicated they were hesitant about taking the vaccine; among individuals of Asian-Pacific Islander descent, 16% responded in the same way. These responses about not taking the vaccine were higher vs. Hispanic American and white respondents who were more likely to take the vaccine based on that statement.
The percentage in the group aged 18 to 44 years old only changed a few points, including Black individuals and those of Asian-Pacific Islander descent, when asked about taking the vaccine, “if their school, employer, or residential area” required it and the government would guarantee it was safe and effective.
Concern about side effects
Among those who said they were against taking the vaccine or were undecided, Garcia said the survey showed most – 53% – indicated they were concerned about side effects. Another 19% of those hesitant about taking the vaccine indicated they were not comfortable with vaccines and had avoided taking vaccines in the past for other medical conditions. Another 17% of the group said in the survey they did not think they needed the vaccine to protect themselves against the virus.
“We showed here, in this survey, that vaccine hesitancy was lower among patients on dialysis than is reported in the general population,” Garcia said. “But some of the characteristics of vaccine-hesitant people were similar to what you would expect based on a general population survey. We also found that education level was very low among patients on dialysis who were hesitant about taking the vaccine,” Garcia said.
“Among those who did agree to take the vaccine, these were patients in many cases who had already taken the flu vaccine,” Garcia said. “Many also knew someone who died from COVID-19. Both of these factors appeared to make them more willing to take the vaccine.”
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Garcia P. #380. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.
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