Low Insurance Coverage is Associated with Slower COVID-19 Vaccine Rollout and Housing Problems Are Most Strongly Related to 2021 Incidence Across the United States

Background: Equitable vaccination distribution is a priority for outcompeting the transmission of COVID-19. A recent CDC study found that US counties with high social vulnerability – according to metrics such as poverty, unemployment and low income – have significantly lower rates of vaccination compared to the national average. We build upon this analysis to assess the impact of demographic, socioeconomic, and environmental factors on county-level vaccination rates and COVID-19 incidence changes.  Methods: Using data from 3,142 US counties (with over 328 million individuals), we computed Spearman rank-order correlations between the outcome variables (cumulative vaccination rate, change in COVID-19 incidence) and 68 demographic, environmental, and socioeconomic factors. We also performed analysis using multivariate linear regression to adjust for age as a potential confounding variable. Finally, we performed fold change analysis on counties stratified by vaccination rates to compute relative risks along with Fisher test p-value associated with these features.  Findings: Our analysis reveals that counties with high levels of uninsured individuals have significantly lower COVID-19 vaccination rates (Spearman correlation: -0.463). We separately assessed factors associated with COVID-19 incidence rates and found that the percent of a county’s population with severe housing problems and high housing costs were strongly correlated with COVID-19 incidence (Spearman correlations: 0.337, 0.314, p-values: <1e-34, <1e-50).  Interpretation: This study shows that socioeconomic factors are correlated not just to COVID-19 vaccination rates but also to COVID-19 incidence fluctuations, underscoring the need to improve COVID-19 vaccination campaigns in marginalized communities.   Funding: This work was supported by nference, inc. Declaration of Interest: EL, MC, GD, CP, and VS are employees of nference and have financial interests in the company.