Improving Data Quality Essential for Addressing Health Equity
chandni
During the ongoing COVID-19 pandemic, policymakers and healthcare stakeholders have faced challenges in promoting health equity due to gaps and inconsistencies in data. These limitations have impeded the measurement of disparities in COVID-19 vaccine distribution, a crucial aspect of combating severe illness. Issues such as the absence of standardized procedures and definitions for race and ethnicity data, as well as inadequate data sharing capabilities across systems, have hindered the accurate assessment of vaccine uptake disparities. Regional data has proven to be inconsistent and varied, while federal data, although consistent, utilizes outdated standards that prevent in-depth analysis and often lack crucial race and ethnicity information. To ensure fair and equitable policy decisions, it is crucial to establish comparable federal and regional data that minimizes the risk of data artifacts and enables effective resource allocation.
The impact of longstanding health inequities has been evident throughout the pandemic, with people of color disproportionately experiencing higher rates of COVID-19 infections, hospitalizations, and deaths. Recognizing this disparity, national vaccination distribution strategies aimed to provide equitable access, especially for communities of color. Analysis of national and state-level vaccination data segregated by race and ethnicity indicates a narrowing gap between White and minority populations since the vaccine rollout began. However, these broad trends mask significant local variations, making it difficult to implement targeted responses at the community level.
In spring 2021, an initiative was undertaken to create a regularly updated nationwide map depicting county-level vaccination coverage in the United States, disaggregated by race and ethnicity. However, challenges arose due to differences in reporting styles and incomplete data coverage across states, preventing a comprehensive view of county-level disparities on a national scale. Even among states where county-level data is available through public dashboards, significant gaps, limitations, and inconsistencies hinder the comparison of vaccination rates among different racial and ethnic groups within and across states. In this context, it is imperative to obtain comprehensive, granular data on race and ethnicity, not only for addressing COVID-19-related disparities but also for broader public health and healthcare initiatives.
County-level Disparities Highlight Variability in Racial Vaccination Rates
National and state-level vaccination data can obscure local disparities that have distinct underlying causes. By examining county-level estimates disaggregated by race and ethnicity, the most detailed geographic unit analyzed at a national level, significant differences in vaccination coverage become apparent. As of March 29, 2022, reliable data on county-level first-dose vaccinations among White and Black populations was available for 827 counties across 13 states, representing 40% of the population aged five and above, 31% of the White population aged five and above, and 40% of the Black population aged five and above in the United States. Due to comparability considerations, other racial and ethnic groups were excluded, emphasizing the need to address this omission.
In April 2021, vaccination coverage among the White population was 13 percentage points higher than among the Black population. However, based on our dataset as of March 2022, the vaccination gap had decreased, with the Black population lagging behind by 9 percentage points, consistent with national reports at that time. Nevertheless, county-level data reveals significant local variations. In most states, average vaccination coverage among Whites exceeded that of Blacks. However, exceptions exist, with states like Alabama, Georgia, and Oregon exhibiting higher average vaccination rates among Blacks. Among the counties in our dataset, 32% showed higher vaccination rates among Blacks compared to Whites (Exhibit 1). In 43% of counties, Whites had higher vaccination rates than Blacks, while the remaining 25% of counties demonstrated equitable vaccination rates for both populations. Even in states with pronounced inequities between Whites and Blacks, such as California, the differences between counties were
more substantial than the statewide averages. These diverse disparities across counties underscore the necessity for tailored, localized strategies in addressing health inequities and highlight the inadequacy of a singular, national-level racial analysis approach, which oversimplifies the issue.
