{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T11:57:04Z","timestamp":1782302224205,"version":"3.54.5"},"reference-count":36,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Louisville Metro Department of Public Health and Wellness","award":["OGMB220965B"],"award-info":[{"award-number":["OGMB220965B"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Infectious diseases accounted for approximately 18.4% of global mortality in 2019. According to the World Health Organization (WHO), vaccines are available for about 30 potentially lethal diseases. Vaccination prevents substantial mortality and hospitalization. However, its ability to improve overall public health depends on equitable access across all populations, regardless of race, ethnicity, education, or socioeconomic status. Objectives: This study aims to examine how disparities in social determinants of health (SDOH) affect COVID-19 vaccination uptake across Jefferson County, Kentucky. Using ZIP code\u2013level spatial mapping, this study investigates the intersection of SDOH, racial composition, and geographic characteristics to identify inequities and inform equitable interventions. Methods: Data from the Kentucky Immunization Registry (KYIR) were analyzed to assess two-dose COVID-19 vaccination rates at the ZIP code and regional levels in Jefferson County, Kentucky. Vaccination rates were stratified by race and ethnicity and linked with SDOH, including education, employment, insurance status, and income, obtained from the 2021 American Community Survey. Results: By May 2021, vaccination rates ranged from 25.9% in the West region to 57.0% in the Inner East region; by May 2022, these rates increased to 46.2% and 73.9%, respectively. White residents consistently had the highest two-dose vaccination rates (66.4% by May 2022), while Black and Hispanic residents had lower rates (45.7% and 43.9%, respectively). Vaccination rates were strongly correlated with SDOH, especially educational attainment, average family income, and employment rate, underscoring the role of socioeconomic inequities in vaccination disparities. Conclusions: Geographical and racial disparities emphasize the influence of social and economic inequality on vaccine uptake.<\/jats:p>","DOI":"10.3390\/vaccines13121241","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T09:36:39Z","timestamp":1765791399000},"page":"1241","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Geographical Patterns of COVID-19 Vaccine Inequality by Race and Ethnicity and Sociodemographic Determinants of Health: Evidence from Louisville, Kentucky"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3796-8141","authenticated-orcid":false,"given":"Seyed M.","family":"Karimi","sequence":"first","affiliation":[{"name":"Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"},{"name":"Division of Population Health, Louisville Metro Department of Public Health and Wellness, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir Hossein","family":"Hassani","sequence":"additional","affiliation":[{"name":"School of Medicine, Shiraz University of Medical Sciences, Shiraz 71348-51156, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Zarei","sequence":"additional","affiliation":[{"name":"Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mana","family":"Moghadami","sequence":"additional","affiliation":[{"name":"Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Yasin Ali","family":"Parh","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8268-5984","authenticated-orcid":false,"given":"Shaminul H.","family":"Shakib","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Sciences, Sam Houston State University, Huntsville, TX 77340, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5913-6207","authenticated-orcid":false,"given":"Venetia","family":"Aranha","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Mansouri","sequence":"additional","affiliation":[{"name":"Department of Economics (DSE), Alma Mater Studiorum Universit\u00e0 di Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trey","family":"Allen","sequence":"additional","affiliation":[{"name":"Division of Population Health, Louisville Metro Department of Public Health and Wellness, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Population Health, Louisville Metro Department of Public Health and Wellness, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirajum Munira","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzaneh","family":"Raoofi","sequence":"additional","affiliation":[{"name":"Department of Mathematics, College of Arts & Sciences, University of Louisville, Louisville, KY 40292, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepideh","family":"Poursafargholi","sequence":"additional","affiliation":[{"name":"Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY 40292, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Ingram","sequence":"additional","affiliation":[{"name":"Down Syndrome of Louisville, Louisville, KY 40204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela","family":"Graham","sequence":"additional","affiliation":[{"name":"Division of Population Health, Louisville Metro Department of Public Health and Wellness, Louisville, KY 40202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"757","DOI":"10.15585\/mmwr.mm7123a2","article-title":"COVID-19 Vaccination Coverage, by Race and Ethnicity-National Immunization Survey Adult COVID Module, United States, December 2020\u2013November 2021","volume":"71","author":"Kriss","year":"2022","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_2","unstructured":"WHO (2025, August 12). Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Available online: https:\/\/www.who.int\/teams\/immunization-vaccines-and-biologicals\/strategies\/ia2030."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S2352-4642(21)00311-4","article-title":"Global, regional, and national causes of under-5 mortality in 2000-19: An updated systematic analysis with implications for the Sustainable Development Goals","volume":"6","author":"Perin","year":"2022","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Bor, J., Assoumou, S.A., Lane, K., Diaz, Y., Ojikutu, B.O., Raifman, J., and Levy, J.I. (2023). Inequities in COVID-19 vaccine and booster coverage across Massachusetts ZIP codes after the emergence of Omicron: A population-based cross-sectional study. PLoS Med., 20.","DOI":"10.1371\/journal.pmed.1004167"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2411656","DOI":"10.1001\/jamanetworkopen.2024.11656","article-title":"Racial and Ethnic Disparities in COVID-19 Mortality","volume":"7","author":"Sumibcay","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Karimi, S.M., Khan, S.M., Moghadami, M., Parh, M.Y.A., Shakib, S.H., Zarei, H., Poursafargholi, S., and Little, B.B. (2025). Multidimensional Demographic Analyses of COVID-19 Vaccine Inequality in the United States: A Systematic Review. Healthcare, 13.","DOI":"10.3390\/healthcare13020139"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"9959","DOI":"10.18632\/aging.103344","article-title":"Why does COVID-19 disproportionately affect older people?","volume":"12","author":"Mueller","year":"2020","journal-title":"Aging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s00281-023-00998-0","article-title":"Causes and costs of global COVID-19 vaccine inequity","volume":"45","author":"Ferranna","year":"2024","journal-title":"Semin. Immunopathol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Karimi, S.M., Moghadami, M., Parh, M.Y.A., Shakib, S.H., Zarei, H., Aranha, V., Poursafargholi, S., Allen, T., Little, B.B., and Antimisiaris, D. (2025). COVID-19 Vaccine Uptake Inequality Among Adults: A Multidimensional Demographic Analysis. COVID, 5.","DOI":"10.3390\/covid5050075"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/S2213-2600(20)30234-4","article-title":"COVID-19 and the impact of social determinants of health","volume":"8","author":"Abrams","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_11","unstructured":"Artiga, S., Garfield, R., and Orgera, K. (2020). Communities of Color at Higher Risk for Health and Economic Challenges due to COVID-19, KFF."},{"key":"ref_12","unstructured":"CDC (2025, August 12). Ensuring Vaccine Access for All People, Available online: https:\/\/www.cdc.gov\/vaccines\/basics\/vaccine-equity.html."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S43","DOI":"10.1097\/PHH.0000000000001263","article-title":"Revealing the unequal burden of COVID-19 by income, race\/ethnicity, and household crowding: US county versus zip code analyses","volume":"27","author":"Chen","year":"2021","journal-title":"J. Public Health Manag. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Shakib, S.H., Little, B.B., Karimi, S.M., and Goldsby, M. (2025). COVID-19 Mortality Among Hospitalized Medicaid Patients in Kentucky (2020\u20132021): A Geospatial Study of Social, Medical, and Environmental Risk Factors. Atmosphere, 16.","DOI":"10.3390\/atmos16060684"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Medcalfe, S.K., and Slade, C.P. (2023). Racial residential segregation and COVID-19 vaccine uptake: An analysis of Georgia USA county-level data. BMC Public Health, 23.","DOI":"10.1186\/s12889-023-16235-0"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Mody, A., Bradley, C., Redkar, S., Fox, B., Eshun-Wilson, I., Hlatshwayo, M.G., Trolard, A., Tram, K.H., Filiatreau, L.M., and Thomas, F. (2022). Quantifying inequities in COVID-19 vaccine distribution over time by social vulnerability, race and ethnicity, and location: A population-level analysis in St. Louis and Kansas City, Missouri. PLoS Med., 19.","DOI":"10.1101\/2022.06.13.22276312"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18443","DOI":"10.1038\/s41598-021-97705-6","article-title":"Social and economic inequality in coronavirus disease 2019 vaccination coverage across Illinois counties","volume":"11","author":"Liao","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s11524-021-00589-0","article-title":"COVID-19 vaccine rollouts and the reproduction of urban spatial inequality: Disparities within large US cities in March and April 2021 by racial\/ethnic and socioeconomic composition","volume":"99","author":"DiRago","year":"2022","journal-title":"J. Urban Health"},{"key":"ref_19","unstructured":"(2025, August 14). Census, Available online: https:\/\/www.census.gov\/programs-surveys\/acs\/technical-documentation\/table-and-geography-changes\/2021\/5-year.html."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Tahir, I.M., Kumar, V., Faisal, H., Gill, A., Kumari, V., Tahir, H.M., and Haque, M.A. (2024). Contagion comeback: Unravelling the measles outbreak across the USA. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1491927"},{"key":"ref_21","unstructured":"United States Census Bureau (2025, August 17). Jefferson County, Kentucky, Available online: https:\/\/data.census.gov\/profile\/Jefferson_County,_Kentucky?g=050XX00US21111."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.ajic.2024.09.007","article-title":"COVID-19 vaccine uptake inequality among older adults: A multidimensional demographic analysis","volume":"53","author":"Karimi","year":"2025","journal-title":"Am. J. Infect. Control"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Karimi, S.M., Moghadami, M., Parh, M.Y.A., Shakib, S.H., Zarei, H., Aranha, V., Poursafargholi, S., Allen, T., Little, B.B., and Antimisiaris, D. (2025). COVID-19 Vaccine Uptake Inequality Among Children: A Multidimensional Demographic Analysis. Healthcare, 13.","DOI":"10.3390\/healthcare13091019"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Xu, Z., and Jiang, B. (2022). Effects of social vulnerability and spatial accessibility on COVID-19 vaccination coverage: A census-tract level study in Milwaukee County, USA. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912304"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2404","DOI":"10.1016\/j.vaccine.2023.02.079","article-title":"Racial and ethnic disparities in COVID-19 vaccine uptake: A mediation framework","volume":"41","author":"Na","year":"2023","journal-title":"Vaccine"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Shakib, S.H., Karimi, S.M., McGeeney, J.D., Parh, M.Y.A., Zarei, H., Chen, Y., Goldman, B., Novario, D., Schurfranz, M., and Warren, C.A. (2025). Local Health Department COVID-19 Vaccination Efforts and Associated Outcomes: Evidence from Jefferson County, Kentucky. Vaccines, 13.","DOI":"10.3390\/vaccines13090901"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e34163","DOI":"10.2196\/34163","article-title":"Demographic determinants and geographical variability of COVID-19 vaccine hesitancy in underserved communities: Cross-sectional study","volume":"9","author":"Matas","year":"2023","journal-title":"JMIR Public Health Surveill."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e2144470","DOI":"10.1001\/jamanetworkopen.2021.44470","article-title":"Changes in COVID-19 vaccine hesitancy among Black and White individuals in the US","volume":"5","author":"Padamsee","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Savoia, E., Masterson, E., Olander, D.R., Anderson, E., Mohamed Farah, A., and Pirrotta, L. (2024). Determinants of vaccine hesitancy among African American and black individuals in the United States of America: A systematic literature review. Vaccines, 12.","DOI":"10.20944\/preprints202401.1417.v1"},{"key":"ref_30","first-page":"146","article-title":"Public Trust in Healthcare System in Iran: A Rapid Assessment During the COVID-19 Epidemic in Iran","volume":"8","author":"Imanieh","year":"2021","journal-title":"Epidemiol. Health Syst. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s11524-021-00594-3","article-title":"Strategies that promote equity in COVID-19 vaccine uptake for black communities: A review","volume":"99","author":"Dada","year":"2022","journal-title":"J. Urban Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1007\/s40615-022-01231-8","article-title":"Context and considerations for the development of community-informed health communication messaging to support equitable uptake of COVID-19 vaccines among communities of color in Washington, DC","volume":"10","author":"Kerrigan","year":"2023","journal-title":"J. Racial Ethn. Health Disparities"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Sallam, M. (2021). COVID-19 vaccine hesitancy worldwide: A concise systematic review of vaccine acceptance rates. Vaccines, 9.","DOI":"10.1101\/2020.12.28.20248950"},{"key":"ref_34","first-page":"e85544","article-title":"COVID-19 Vaccine Willingness and Education Level: A Multinational Cross-Sectional Analysis","volume":"17","author":"Karp","year":"2025","journal-title":"Cureus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"436","DOI":"10.26719\/2025.31.7.436","article-title":"Income inequality and willingness to accept COVID-19 vaccination in Islamic Republic of Iran","volume":"31","author":"Badiee","year":"2025","journal-title":"East. Mediterr. Health J."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Mosbah, E.B., and Dharmapala, P.S. (2022). Evaluating the Effects of COVID-19 and Vaccination on Employment Behaviour: A Panel Data Analysis Acrossthe World. Sustainability, 14.","DOI":"10.3390\/su14159675"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/12\/1241\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T10:08:18Z","timestamp":1765793298000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/12\/1241"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,13]]},"references-count":36,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["vaccines13121241"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13121241","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,13]]}}}