{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T07:16:39Z","timestamp":1781766999412,"version":"3.54.5"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T00:00:00Z","timestamp":1723161600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["6 U48DP006400-02-01"],"award-info":[{"award-number":["6 U48DP006400-02-01"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Geographic variation in COVID-19 vaccination can create areas at higher risk of infection, complications, and death, exacerbating health inequalities. This ecological study examined geographic patterns of COVID-19 vaccine completion, using age and sociodemographic characteristics as possible explanatory mechanisms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>Using 2020\u20132022 data from the North Carolina COVID-19 Vaccination Management System and U.S. Census Bureau American Community Survey, at the Zip code-level, we evaluated completion of the primary COVID-19 vaccine series across age groups. We examined geographic clustering of age-specific completion by Zip code and evaluated similarity of the age-specific geographic patterns. Using unadjusted and adjusted spatial autoregressive models, we examined associations between sociodemographic characteristics and age-specific vaccine completion. COVID-19 vaccine completion was moderately geographically clustered in younger groups, with lower clustering in older groups. Urban areas had clusters of higher vaccine completion. Younger and middle-aged groups were the most similar in completion geographically, while the oldest group was most dissimilar to other age groups. Higher income was associated with higher completion in adjusted models across all age groups, while a higher percent of Black residents was associated with higher completion for some groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>COVID-19 vaccination completion is more variable among younger age groups in North Carolina, and it is higher in urban areas with higher income. Higher completion in areas with more Black residents may reflect the success of racial equity efforts in the state. The findings show a need to reach younger populations and lower income areas that were not prioritized during early vaccination distribution.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0304812","type":"journal-article","created":{"date-parts":[[2024,8,9]],"date-time":"2024-08-09T17:37:34Z","timestamp":1723225054000},"page":"e0304812","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["The geography of COVID-19 vaccine completion by age in North Carolina, U.S."],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1452-875X","authenticated-orcid":true,"given":"Hilary","family":"Sandborn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Delamater","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel T.","family":"Brewer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa B.","family":"Gilkey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Emch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,9]]},"reference":[{"key":"pone.0304812.ref001","author":"CDC Museum COVID-19 Timeline","year":"2022","journal-title":"Centers for Disease Control and Prevention"},{"key":"pone.0304812.ref002","doi-asserted-by":"crossref","first-page":"e1004069","DOI":"10.1371\/journal.pmed.1004069","article-title":"Disparities in distribution of COVID-19 vaccines across US counties: A geographic information system\u2013based cross-sectional study.","volume":"19","author":"I Hernandez","year":"2022","journal-title":"PLOS Medicine"},{"key":"pone.0304812.ref003","doi-asserted-by":"crossref","first-page":"e2113937","DOI":"10.1001\/jamanetworkopen.2021.13937","article-title":"Assessment of Racial and Ethnic Disparities in Access to COVID-19 Vaccination Sites in Brooklyn, New York.","volume":"4","author":"N Williams","year":"2021","journal-title":"JAMA Network Open"},{"key":"pone.0304812.ref004","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1377\/hlthaff.2021.01055","article-title":"Sociodemographic Disparities In Access To COVID-19 Vaccines Upon Initial Rollout In Florida.","volume":"40","author":"J Attonito","year":"2021","journal-title":"Health Affairs"},{"key":"pone.0304812.ref005","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1038\/d41586-022-01827-4","article-title":"Did COVID vaccine mandates work? 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