Multimorbidity and COVID-19 Vaccine and Booster Uptake among Adults in the United States
Main Article Content
Abstract
Background and Objectives: While prior research has linked individual chronic conditions to higher COVID-19 vaccine uptake, little is known about how multimorbidity influences both primary vaccine series and booster uptake. This study aims to evaluate the association between multimorbidity and COVID-19 vaccination and booster behaviors among adults in the United States.
Methods: A cross-sectional analysis was conducted using the 2022 Medical Expenditure Panel Survey (MEPS), a nationally representative dataset. Adults aged ≥18 years with complete data on vaccination, booster status, and chronic conditions were included (n = 17,172). COVID-19 vaccination and booster statuses were self-reported. Chronic disease conditions were categorized as none, one, or two or more chronic conditions (i.e., multimorbidity). Covariates included age, sex, race and ethnicity, social determinants of health, pain level, and lifestyle variables. Survey-weighted logistic regression models were used to estimate unadjusted and adjusted odds ratios (AOR) for vaccine and booster uptake associated with multimorbidity.
Results: After adjusting for all covariates, adults with multimorbidity had significantly higher odds of receiving the primary COVID-19 vaccine series compared to those with a single chronic condition (AOR = 1.28, 95% CI: 1.07–1.53, p = 0.0045). In contrast, multimorbidity was not significantly associated with booster uptake (AOR = 0.95, 95% CI: 0.81–1.12, p = 0.5458).
Conclusions: Multimorbidity is independently associated with increased uptake of the primary COVID-19 vaccine series but not with booster vaccination. These findings highlight the need for targeted strategies to promote booster uptake among individuals with multiple chronic conditions.
Article Details
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References
2. Barouch DH. Covid-19 Vaccines - Immunity, Variants, Boosters. N Engl J Med. 2022;387(11):1 011-1020.
3. Rosenblum HG, Wallace M, Godfrey M, et al. Interim Recommendations from the Advisory Committee on Immunization Practices for the Use of Bivalent Booster Doses of COVID-19 Vaccines - United States, October 2022. MMWR Morb Mortal Wkly Rep. 2022;71(45):1436-1441.
4. Kriss JL, Black CL, Razzaghi H, et al. Influenza, COVID-19, and Respiratory Syncytial Virus Vaccination Coverage Among Adults - United States, Fall 2024. MMWR Morb Mortal Wkly Rep. 2024;73(46):1044-1051.
5. Roy DN, Biswas M, Islam E, Azam MS. Potential factors influencing COVID-19 vaccine acceptance and hesitancy: A systematic review. PLoS One. 2022; 17(3):e0265496.
6. Bennett MM, Douglas M, da Graca B, Sanchez K, Powers MB, Warren AM. Attitudes and personal beliefs about the COVID-19 vaccine among people with COVID-19: a mixed-methods analysis. BMC Public Health. 2022;22(1):1936.
7. McElfish PA, Selig JP, Scott AJ, et al. Associations between 5-year influenza vaccination and sociodemographic factors and healthcare access among Arkansans. Vaccine. 2022;40(27):3727-3731.
8. Watanabe A, Iwagami M, Yasuhara J, Takagi H, Kuno T. Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis. Vaccine. 2023;41(11):1783-1790.
9. Yang J, Rai KK, Alfred T, et al. The impact of COVID vaccination on incidence of long COVID and healthcare resource utilisation in a primary care cohort in England, 2021-2022. BMC Infect Dis. 2025;25(1):214.
10. Aw J, Seng JJB, Seah SSY, Low LL. COVID-19 Vaccine Hesitancy-A Scoping Review of Literature in High-Income Countries. Vaccines (Basel). 2021;9(8).
11. Nindrea RD, Usman E, Katar Y, Sari NP. Acceptance of COVID-19 vaccination and correlated variables among global populations: A systematic review and meta-analysis. Clin Epidemiol Glob Health. 2021;12:100899.
12. Boey L, Bosmans E, Ferreira LB, et al. Vaccination coverage of recommended vaccines and determinants of vaccination in at-risk groups. Hum Vaccin Immunother. 2020;16(9):2136-2143.
13. Machado A, Kislaya I, Santos AJ, et al. Factors associated to repeated influenza vaccination in the Portuguese adults with chronic conditions. Vaccine. 2018;36(35):5265-5272.
14. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43.
15. Chudasama YV, Zaccardi F, Gillies CL, et al. Patterns of multimorbidity and risk of severe SARS-CoV-2 infection: an observational study in the U.K. BMC Infect Dis. 2021;21(1):908.
16. Lujic S, Randall DA, Simpson JM, Falster MO, Jorm LR. Interaction effects of multimorbidity and frailty on adverse health outcomes in elderly hospitalised patients. Sci Rep. 2022;12(1):14139.
17. Guiding principles for the care of older adults with multimorbidity: an approach for c. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012;60(10):E1-E25.
18. Jacobs ET, Cordova-Marks FM, Farland LV, et al. Understanding low COVID-19 booster uptake among US adults. Vaccine. 2023;41(42):6221-6226.
19. Agaku IT, Adeoye C, Long TG. Geographic, Occupational, and Sociodemographic Variations in Uptake of COVID-19 Booster Doses Among Fully Vaccinated US Adults, December 1, 2021, to January 10, 2022. JAMA Netw Open. 2022;5(8):e2227680.
20. Kawai K, Kawai AT. Racial/Ethnic and Socioeconomic Disparities in Adult Vaccination Coverage. Am J Prev Med. 2021;61(4):465-473.
21. Felzer JR, Montgomery AJ, LeMahieu AM, et al. Disparities in Influenza, Pneumococcal, COVID-19 Vaccine Coverage in High-Risk Adults Aged 19 to 64 Years in Southeastern Minnesota, 2010-2021. Chest. 2024;166(1):49-60.
22. Tegegne MD, Girma S, Mengistu S, et al. Willingness to receive COVID-19 vaccine and associated factors among adult chronic patients. A cross-sectional study in Northwest Ethiopia. PLoS One. 2022;17(7):e0269942.
23. Zhao Y, Du J, Li Z, et al. It is time to improve the acceptance of COVID-19 vaccines among people with chronic diseases: A systematic review and meta-analysis. J Med Virol. 2023;95(2):e28509.
24. Lu PJ, Hung MC, Jackson HL, et al. COVID-19 Vaccination and Intent for Vaccination of Adults With Reported Medical Conditions. Am J Prev Med. 2022; 63(5):760-771.
25. Harrison SM, Wei MY, Lamerato LE, Petrie JG, Toth Martin E. Multimorbidity is associated with uptake of influenza vaccination. Vaccine. 2018;36 (25):3635-3640.
26. Gaffney A, Woolhandler S, Bor J, McCormick D, Himmelstein DU. Community Health, Health Care Access, And COVID-19 Booster Uptake In Massachusetts. Health Aff (Millwood). 2023;42(2):2 68-276.