Chief Medical Informatics Officer Illumination Health, United States
Background: COVID-19 vaccine uptake in autoimmune and inflammatory rheumatic disease (AIIRD) patients is an area of concern to rheumatologists and other providers. Vaccine guidelines from the CDC and ACR recommend using the immunocompromised patient schedule for vaccine administration in patients with AIIRD treated with immunosuppressive medications.
Objectives: To ascertain COVID-19 vaccine uptake and reasons for hesitancy in a large rheumatology community practice-based research network.
Methods: A tablet-based survey was deployed by 101 rheumatology practices as part of routine care from 12/2021-12/2022. Patients were asked about COVID-19 vaccine status for the primary series plus booster(s) and reasons they might not or did not receive a vaccine or booster. Patients providing a reason(s) for lack of primary series vaccination were considered vaccine-hesitant; those stating why they might not receive a booster were deemed booster-hesitant.
We used descriptive statistics to explore the differences between vaccination status and vaccine or booster hesitancy, comparing AIIRD to non-AIIRD patients. We used multivariable logistic regression to examine the association between vaccine uptake and AIIRD status and reported adjusted odds ratios (aOR).
Results: Of the 65,333 patients who answered at least one survey, 89% reported receiving at least one dose of the vaccine; of the vaccinated, 70% reported having at least one booster. Vaccinated patients were older (64.2 ± 14 vs. 56.7 ± 14) and less likely to have rheumatoid arthritis (39% vs. 44%). AIIRD patients made up 64% of the cohort. A significantly greater proportion of AIIRD patients were vaccine-hesitant (15% vs. 9%) and booster-hesitant (36% vs. 27%) compared to non-AIIRD patients.
Concerns about long-term safety (29%) and side effects (24%) were cited as primary barriers in vaccine-hesitant patients, while lack of recommendation from the physician was the primary factor for booster hesitancy (34%).
Among the vaccine hesitant, 13% later reported vaccination, and 64% of the booster hesitant later reported receiving a booster. After adjusting for age, race, and ethnicity, AIIRD patients were significantly less likely to receive the vaccine (aOR: 0.71; 95% CI: 0.67, 0.75) versus non-AIIRD patients.
Conclusions: Despite the wide availability and need for COVID-19 vaccine in immunocompromised patients, hesitancy about the vaccine remains a concern. AIIRD patients were less likely to be vaccinated than non-AIIRD patients. Healthcare providers should recommend vaccination and boosters in these at-risk populations when appropriate. Based on the observation, some vaccine and booster-hesitant patients eventually receive vaccination, and interventions focused on these populations may be fruitful.
