Vaccine uptake is critical for mitigating the impact of COVID-19 in the United States, but structural inequities pose a serious threat to progress. Racial disparities in vaccination persist despite the increased availability of vaccines. We ask what factors are associated with such disparities. We combine data from state, federal, and other sources to estimate the relationship between social determinants of health and racial disparities in COVID-19 vaccinations at the county level. Analyzing vaccination data from 19 April 2021, when nearly half of the US adult population was at least partially vaccinated, we find associations between racial disparities in COVID-19 vaccination and median income (negative), disparity in high school education (positive), and vote share for the Republican party in the 2020 presidential election (negative), while vaccine hesitancy is not related to disparities. We examine differences in associations for COVID-19 vaccine uptake as compared with influenza vaccine. Key differences include an amplified role for socioeconomic privilege factors and political ideology, reflective of the unique societal context in which the pandemic has unfolded.

疫苗接种对于减轻 COVID-19 在美国的影响至关重要，但结构性不平等对进展构成严重威胁。尽管疫苗的供应增加了，但疫苗接种方面的种族差异仍然存在。我们询问哪些因素与这种差异有关。我们结合来自州、联邦和其他来源的数据来估计县级 COVID-19 疫苗接种中健康的社会决定因素与种族差异之间的关系。分析 2021 年 4 月 19 日的疫苗接种数据，当时近一半的美国成年人至少部分接种了疫苗，我们发现 COVID-19 疫苗接种的种族差异与收入中位数（负）、高中教育差异（正）和共和党在 2020 年总统大选中的投票份额（负），而疫苗犹豫与差异无关。我们研究了与流感疫苗相比，COVID-19 疫苗接种关联的差异。主要差异包括社会经济特权因素和政治意识形态的放大作用，反映了流行病发生的独特社会背景。