P0583 - Vaccine Hesitancy Towards COVID Vaccination in IBD Patients in a Diverse Safety Net Hospital Patient Population

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

HH

Howard Herman, MD

Boston Medical Center
Boston, MA, United States

Howard Herman, MD¹, Max Rosenthaler, MD², Venkata R. Satyam, MD¹, Sharmeel Wasan, MD¹
¹Boston Medical Center, Boston, MA; ²Boston Medical Center, Dorchester, MA

Introduction: A recent Gallup poll found that 25% of Americans would decline the COVID-19 vaccine if offered at no cost. Underrepresented minority (URM) and IBD patients historically have lower vaccination rates. We surveyed IBD patients to identify concerns regarding COVID vaccination, particularly among a URM population.

Methods: Participants were recruited from 1265 adult patients at Boston Medical Center (BMC) with diagnosis codes for IBD obtained from the EMR. Patients were sent an electronic survey assessing attitudes regarding Covid-19 vaccination. To ensure a diverse and representative study population, Hispanic and Black patients, non-English speakers, and those without access to MyChart completed the survey by phone. The primary outcome was vaccination intent. Subjects were defined as vaccine hesitant if they were not already vaccinated or planning to be as soon as possible. Analyses were performed to identify factors associated with vaccination intent. This study was approved by the IRB of BMC.

Results: A total of 210 participants (159 electronic, 51 phone) completed the survey. The response rate was 16.6%. Demographics, clinical characteristics, and rates of vaccine hesitancy are presented in Table 1. The percentage of vaccine hesitant patients was 11.9%. The rate of vaccine hesitancy was higher in Hispanic (27.8% vs 6.4%), Black (15.9% vs 11.3%), Male (15.8% vs 9.7%), and Spanish-speaking patients (25% vs 8.5%). Immunosuppressed patients had lower rates of vaccine hesitancy (9.6% vs 15.1%). Chi-squared tests of independence showed that primary language and Hispanic ethnicity were significantly associated with vaccine hesitancy (p = 0.0102 and p < 0.0001). Multivariate logistic regression including age, Hispanic ethnicity, and preferred language revealed a significant association of age and Hispanic ethnicity with vaccine hesitancy and no significant association of primary language with vaccine hesitancy.

Discussion: COVID vaccination rates in the U.S. lag behind targets despite a surplus of supply. Our study demonstrates a significantly higher rate of COVID-19 vaccine hesitancy among Hispanic participants. Participants gave a variety of reasons for hesitancy and approaches that providers could take to address their concerns. Limitations include response bias inherent to online and phone surveys. Low response rates may overestimate vaccination intent. Targeting outreach toward specific populations with tailored educational interventions may improve COVID-19 vaccination efforts.

	Overall N (%)	Significance (Chi-squared test of independence)
Total Sample:	210 (100%)
Race
1. White	160 (76.2%)
2. Black or African American	44 (21%)
3. Asian Pacific Islander or Native Hawaiian	5 (2.4%)
4. Other	1 (0.48%)
Hispanic	54 (25.7%)
Males	76 (36.2%)
Age (mean ± STD)	46.6 ± 15.1
Level of Education
1. No HS degree	35 (16.7%)
2. HS graduate/GED	51 (24.3%)
3. Some college/ Vocational school/ Technical School	30 (14.3%)
4. Graduated college/ post grad	47 (22.4%)
5. Missing	47 (22.4%)
Primary Language
1. English	165 (78.6%)
2. Spanish	44 (21%)
3. Cape Verdean/ Port Creole	1 (0.47%)
Vaccinated for Flu
1. Yes	154 (73.3%)
2. No	56 (26.6%)
COVID Vaccination Status
1. Already vaccinated	179 (85.2%)
2. Looking to become vaccinated as soon as possible	6 (2.9%)
3. Likely will become vaccinated later this year, but not immediately	12 (5.7%)
4. Unsure if they will get the vaccine	7 (3.3%)
5. Do not want the vaccine	6 (2.9%)
Overall Vaccine Hesitancy (answered 3, 4, or 5 above)	25 (11.9%)
Vaccine Hesitancy by Race	Hesitant N/Total N (% out of race)	P = 0.5652 (excluding “Asian Pacific Islander or Native Hawaiian” and “Other”)
1. White	18/160 (11.3%)
2. Black or African American	7/44 (15.9%)
3. Asian Pacific Islander or Native Hawaiian	0/5 (0%)
4. Other	0/1 (0%)
Vaccine Hesitancy by Hispanic Ethnicity		P < 0.0001*
1. Non-hispanic	10/156 (6.4%)
2. Hispanic	15/54 (27.8%)
Vaccine Hesitancy by Sex		P = 0.2768
1. Male	12/76 (15.8%)
2. Female	13/134 (9.7%)
Vaccine Hesitancy by Level of Education		P = 0.4351
1. No HS degree	6/35 (17.1%)
2. HS graduate/GED	7/51 (13.7%)
3. Some college/ Vocational school/ Technical School	4/30 (13.3%)
4. Graduated college/ post grad	2/47 (4.3%)
5. Missing	6/41 (14.6%)
Vaccine Hesitancy by Primary Language		P = 0.0102* (excluding Cape Verdean/ Port Creole)
1. English	14/165 (8.5%)
2. Spanish	11/44 (25%)
3. Cape Verdean/ Port Creole	0/1 (0%)
Vaccine Hesitancy by Immunosuppression		P = 0.4228
1. Not immunosuppressed	15/106 (15.1%)
2. Immunosuppressed	10/104 (9.6%)
Multivariable Logistic Regression of Vaccine Hesitancy by Age, Hispanic Ethnicity, and Primary Language	z-value
1. Age	-2.225	P = 0.02607*
2. Hispanic Ethnicity	2.690	P = 0.0071*
3. Preferred Language	-0.442	P = 0.65826
Reasons for Vaccine Hesitancy	Overall N (%)
1. Concerned about adverse reaction	18 (72%)
2. Concerned vaccine could interfere with IBD medication efficacy	11 (44%)
3. Concerned IBD med might make vaccination ineffective	9 (36%)
4. Already had COVID	3 (12%)
5. Negative experiences with last vaccine	2 (8%)
6. Generally doesn’t take vaccines	5 (20%)
7. Long term safety of the COVID vaccine is unknown	13 (52%)
8. Concerned vaccine didn’t undergo necessary scrutiny and safety checks	16 (64%)
9. Personal history of allergic reaction	1 (4%)
10. Prefer to watch how others tolerate the vaccine	12 (48%)
What can IBD providers do to better inform you about COVID vaccines?
1. Have a risk/benefit conversation about it	11 (44%)
2. Provide handout information about the vaccine	8 (32%)
3. Provide data about the efficacy among patients with IBD and other immune diseases	10 (40%)
4. Provide data about vaccine efficacy/safety among patients with IBD	9 (36%)
5. Nothing	11 (44%)
6. Unsure	2 (8%)

Table: Table 1: Summary Data and Statistical Analyses of Survey Results

Disclosures:

Howard Herman indicated no relevant financial relationships.

Max Rosenthaler indicated no relevant financial relationships.

Venkata Satyam indicated no relevant financial relationships.

Sharmeel Wasan: Pfizer – Grant/Research Support.

Howard Herman, MD¹, Max Rosenthaler, MD², Venkata R. Satyam, MD¹, Sharmeel Wasan, MD¹. P0583 - Vaccine Hesitancy Towards COVID Vaccination in IBD Patients in a Diverse Safety Net Hospital Patient Population, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.