Medical mistrust and vaccine-hesitant attitudes explain SARS-CoV-2 vaccination disparities in a mixed serostatus cohort.

IF 3.4 2区医学 Q3 IMMUNOLOGY AIDS Pub Date : 2025-02-01 Epub Date: 2024-11-04 DOI:10.1097/QAD.0000000000004053

M Reuel Friedman, Gina Wingood, Kristen D Krause, Sarah Krier, Gypsyamber D'Souza, Mirjam-Colette Kempf, Matthew J Mimiaga, Jenn Kwait, Deborah L Jones, Jeremy Martinson, Ernesto T Marques, Phyllis Tien, Kathryn Anastos, Catalina Ramirez, Mardge Cohen, Marlene Camacho-Rivera, Lakshmi Goparaju, Charles R Rinaldo

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Abstract

Objectives: To understand the extent of racial disparities in SARS-CoV-2 vaccination among PWH and those vulnerable to HIV infection and to estimate the contributions of medical mistrust and vaccine-hesitant attitudes to these disparities.

Design: Quantitative data analyses in a racially and gender-diverse, mixed-serostatus prospective cohort, the Multicenter AIDS Cohort Study (MACS)/Women's Interagency HIV Study (WIHS) Combined Cohort Study.

Methods: Interviewer-assisted questionnaires assessed SARS-CoV-2 vaccination, medical mistrust, and vaccine-hesitant attitudes from March 2021 to September 2022 ( n = 3948). Longitudinal analyses assessed effects of sociodemographics on medical mistrust and vaccine-hesitant attitudes. A hierarchical multivariable logistic regression assessed effects of these co-factors on SARS-CoV-2 vaccination. Causal mediation models assessed whether medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, and vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 nonvaccination.

Results: Participants' mean age was 56.7; 55.3% were Black, 52.6% cisgender female, 62.6% PWH. 10.1% reported never receiving SARS-CoV-2 vaccinations (13.4% of Black and 4.5% of White participants). Black-identified participants had higher odds of nonvaccination than White participants [aOR = 1.72; 95% confidence interval (CI) 1.08-2.72]. Medical mistrust mediated the relationship between Black identity and vaccine-hesitant attitudes, accounting for 46% of the effect ( P < 0.0001). Vaccine-hesitant attitudes mediated the relationship between Black identity and SARS-CoV-2 nonvaccination to the extent that 57.7% (95% CI 25.3-90.1%) of the disparity would be eliminated if vaccine-hesitant attitudes among Black respondents were reduced to levels reported among other racial groups.

Conclusion: Findings indicate a profound need to build trustworthy healthcare environments to combat medical mistrust and vaccine-hesitant attitudes in Black communities in the United States, including those affected by HIV.

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医疗不信任和疫苗恐惧态度解释了混合血统人群中 SARS-CoV-2 疫苗接种的差异。

目的了解残疾人和易感染艾滋病病毒者在接种 SARS-CoV-2 疫苗方面的种族差异程度，并估计医疗不信任和疫苗恐惧态度对这些差异的影响：设计：对一个种族和性别多元化、混合血统的前瞻性队列--MACS/WIHS联合队列研究--进行定量数据分析：受访者辅助问卷调查评估了 2021 年 3 月至 2022 年 9 月期间的 SARS-CoV-2 疫苗接种情况、对医疗的不信任以及对疫苗的恐惧态度（n=3948）。纵向分析评估了社会人口统计学对医疗不信任和疫苗恐惧态度的影响。分层多变量逻辑回归评估了这些共同因素对 SARS-CoV-2 疫苗接种的影响。因果中介模型评估了 a) 医疗不信任是否中介了黑人身份与疫苗犹豫态度之间的关系，以及 b) 疫苗犹豫态度是否中介了黑人身份与不接种 SARS-CoV-2 疫苗之间的关系：参与者的平均年龄为 56.7 岁；55.3% 为黑人，52.6% 为顺性女性，62.6% 为公共卫生人员。10.1%的参与者称从未接种过 SARS-CoV-2 疫苗（黑人为 13.4%，白人为 4.5%）。黑人参与者未接种疫苗的几率高于白人参与者（aOR = 1.72；95% CI：1.08，2.72）。医疗不信任在黑人身份与不接种疫苗态度之间起到了中介作用，占影响的 46.0%（P 结论：黑人身份与不接种疫苗态度之间的关系是由医疗不信任引起的：研究结果表明，在美国黑人社区，包括受艾滋病影响的黑人社区，亟需建立值得信赖的医疗保健环境，以消除医疗不信任和疫苗恐惧态度。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.