Social and ideological determinants of COVID-19 vaccination status in Spain

Objectives: This study analysed the association between social and ideological determinants with COVID19 vaccine accessibility and hesitancy in the Spanish adult population. Study design: This was a repeated cross-sectional study. Methods: The data analysed are based on monthly surveys conducted by the Centre for Sociological Research between May 2021 and February 2022. Individuals were classified according to their COVID-19 vaccination status into (1) vaccinated (reference group); (2) willing to vaccinate but not vaccinated, proxy of lack of vaccine accessibility; and (3) hesitant, proxy of vaccine hesitancy. Independent variables included social (educational attainment, gender) and ideological determinants (voting in the last elections, importance attached to the health vs the economic impact of the pandemic, and political selfplacement). We estimated odds ratio (OR) and 95% confidence interval (CI) conducting one ageadjusted multinomial logistic regression model for each determinant and then stratified them by gender. Results: Both social and ideological determinants had a weak association with the lack of vaccine accessibility. Individuals with medium educational attainment had higher odds of vaccine hesitancy (OR = 1.44, CI 1.08-1.93) compared with those with high educational attainment. People self-identified as conservative (OR = 2.90; CI 2.02-4.15) and those who prioritised the economic impact (OR = 3.80; CI 2.62-5.49) and voted for parties opposed to the Government (OR = 2.00; CI 1.54-2.60) showed higher vaccine hesitancy. The stratified analysis showed a similar pattern for both men and women. Conclusions: Considering the determinants of vaccine uptake and hesitancy could help to design strategies that increase immunisation at the population level and minimise health inequities. (c) 2023 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4. 0/).

Automated summary

This study examined the relationship between social and ideological factors and COVID-19 vaccine accessibility and hesitancy in the Spanish adult population. The findings suggest that education level, political ideology, and perceived importance of economic impact of the pandemic are associated with vaccine hesitancy.