Social and Structural Determinants of Health as Predictors of COVID-19 Vaccine Hesitancy Among Older Adults in the United States

Background: Although vaccination is one of the greatest accomplishments in public health,
some people, especially older adults, are reluctant to take vaccines. This study examined the
association between the social and structural determinants of health and COVID-19 vaccine
hesitancy among older adults in the United States.
Methods: Secondary data from the Health and Retirement Study (HRS) was used. The HRS
participants were 65 years and older, and the sample size was 2311. Multinomial multivariable
logistic regression models were conducted for this study.
Results: The study shows that social determinants of health (marital status, educational level)
and structural determinants of health (religiosity) were associated with COVID-19 vaccine
hesitancy among older adults in the United States. Intrapersonal level (sociodemographic factors
and perceived risk of disease such as comorbidities, vaccine concern, and history of flu
vaccination) and interpersonal level (marital status and awareness of death from family) were
associated with COVID-19 vaccine hesitancy among older adults in the United States.
Conclusion: The study shows that addressing certain factors within the social and structural
determinants of health may reduce the impact of vaccine hesitancy among older adults.