INTRODUCTION Vaccine hesitancy has both individual and population-level consequences. At the individual level, it increases the risk of transmission while posing a barrier to achieving herd immunity at the population level. Studies have examined the sociodemographic characteristics associated with vaccine hesitancy at a national level in the US, but there is a paucity of state-specific data. METHODS We investigated state-by-state variation in COVID-19 vaccine hesitancy and examined the role of variations in incidence and mortality rates. Self-reported data were obtained from the Household Pulse Survey, a webbased, representative survey of 68348 US adults conducted during 6-18 January 2021. Confirmed COVID-19 incident and mortality cases were obtained from the COVID Tracking Project and standardized as cases per capita based on US census population estimates by state. Adjusted prevalence ratios (APRs) were estimated using Poisson regression in StataV15.1. RESULTS Nationally, 23.5% reported vaccine hesitancy, ranging from 11.7% in Rhode Island, to 40.2% in Louisiana. Factors associated with increased likelihood of being vaccine hesitant included: being Black as compared to White (APR=1.63; 95% CI: 1.53-1.73), having already tested positive for COVID-19 versus never having tested positive (APR=1.18; 95% CI: 1.12-1.25), being female versus male (APR=1.15; 95% CI: 1.11-1.20), and living in a Republican versus Democratic ‘leaning' State (APR=1.26; 95% CI: 1.201.32). Conversely, the likelihood of being vaccine hesitant was lower among those in multi-unit dwelling, those with higher education level and income. One in four Americans indicated vaccine hesitancy, especially women, Blacks and those living in Republican ‘leaning' States. CONCLUSIONS Enhanced and sustained efforts are needed to boost trust and confidence in the COVID-19 vaccines. A better understanding of reasons why specific subgroups object to the vaccine may inform targeted efforts to encourage vaccine confidence and uptake.
- vaccine hesitancy