CDC: Lower Vax Rates in Nursing Homes Among Low-Wage Staff

COVID-19 vaccination rates varied widely among healthcare personnel (HCP) who worked in long-term care facilities (LTCFs), with less than half of aides vaccinated, researchers found.

In March 2021, the highest vaccination rates were seen in physicians and advanced practice providers (75%), while the lowest rates occurred in aides (45.6%), reported James T. Lee, MD, of the CDC, and colleagues.

Not surprisingly, only 11.1% of physicians declined vaccination compared to a third of aides, the authors wrote in Morbidity and Mortality Weekly Report.

Social and demographic factors -- such as lower median income, lower education, greater ethnic diversity and higher poverty rates -- played a role in aides' vaccination rates, they noted.

"This study shows how health disparities exist, not only in communities and neighborhoods, but within the entity of healthcare itself," Panagis Galiatsatos, MD, MHS, of Johns Hopkins University School of Medicine in Baltimore, told MedPage Today.

Galiatsatos, who was not involved in this study, added that "more work needs to be put forward to assure an equitable outcome is achieved in vaccine rates among healthcare staff and employees, especially those employed in long-term care facilities."

Lee characterized the findings as "disappointing." He told MedPage Today that the coverage differences occurred during a month when LTCF workers and residents were both prioritized for vaccination, and "many facilities had on-site vaccination offered through the federal Pharmacy Partnership for Long-Term Care Program."

Since March of 2021, about a third of all COVID-19 related deaths were among LTCF residents and HCPs working in these facilities, Lee and colleagues noted. In a recent prior study of 1,820 healthcare workers who received the Pfizer-BioNTech vaccine, incidence rates of those who received only the first dose alone decreased the risk of COVID-19 infection by 71%, and after the second dose infection risk was decreased by 97%.

During March 1 to April 4, 2021, Lee's group evaluated data from a convenience sample in the National Healthcare Safety Network (NHSN). Data were separated by occupational categories and compared to HCPs working within the same zip code for 300 LTCFs from 47 states.

Of data on 40,212 HCPs available, researchers found 56.8% were vaccinated by April. There were 69.2% of therapists fully vaccinated, followed by ancillary service workers (58.5%) and nurses (56.7%).

"COVID-19 outbreaks have occurred in LTCFs in which residents were highly vaccinated, but transmission occurred through unvaccinated staff members," Lee and colleagues wrote.

"As a practicing clinician, I have seen these vaccine coverage disparities within our own clinical setting -- with physicians and administrators more likely to get vaccinated than aides and nurses," Lee told MedPage Today. "We also know that vaccine coverage in general is lower among LTCF staff than other healthcare personnel."

Aides were less likely to be fully vaccinated if working in LTCFs located in zip codes with lower median income (40.5% vs 48.1%), lower high school completion (42.2% vs 49.3%), greater ethnic diversity (43.5% vs 50.5%), and higher poverty (42.4% vs 49.2%).

Researchers also cited equity implications from their data, as more aides are female, low-wage workers, more likely to be racial and ethnic minorities, and more likely to have preexisting conditions, making them higher risk for severe COVID-19 related outcomes.

The group also reported that while only 0.7% of physicians had recently contracted COVID-19, 2.3% of nurses and 3.0% of aides had recent infections.

"Additional efforts are needed to improve LTCF immunization policies and practices, build confidence in COVID-19 vaccines, and promote COVID-19 vaccination," the authors said, urging vaccine education resources for HCP in LTCFs located in communities with disparities.

Authors acknowledged a number of limitations to this study, which included the lack of generalizability to all LTCFs across the country since this study only included less than 2% of NHSN facilities. Also, aggregated weekly vaccination data used at LTCFs potentially resulted in duplicate reports for HCPs working at multiple sites. Vaccinated data was self-reported by HCPs and not validated by other staff, they noted.

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