COVID-19 vaccination hesitancy among hemodialysis patients: A mixed-methods study

Vaccine hesitancy is a long-standing concept popularized during the coronavirus disease 2019 (COVID-19) pandemic. However, the underlying reasons and factors associated with COVID-19 vaccine hesitancy among hemodialysis patients have not been thoroughly investigated. Thus, here we investigated these issues using a mixed-methods approach. A questionnaire survey was conducted of 1086 voluntary hemodialysis patients at 36 Japanese facilities. The questionnaire asked about detailed background factors, COVID-19 vaccination status, and reasons for non-vaccination. A multivariate logistic regression analysis was conducted of vaccine hesitancy, and 10 unvaccinated patients were interviewed to further investigate their reasons for non-vaccination. There were 54 (5.0 %) unvaccinated and 1032 (95.0 %) vaccinated participants. In the multivariate analysis, COVID-19 vaccine hesitancy was independently associated with a history of anaphylaxis (adjusted odds ratio [aOR], 4.05; 95 % confidence interval [CI], 1.46–11.21), living with an unvaccinated person (OR, 4.90; 95 % CI, 2.51–9.56), and using X (formerly Twitter) as the main source of information (aOR, 8.58; 95 % CI, 1.86–39.58), whereas those who received an annual influenza vaccination were less likely to show COVID-19 vaccine hesitancy (aOR, 0.19; 95 % CI, 0.1–0.36). The interview findings suggested that other factors associated with non-vaccination were not included in the questionnaire survey, such as missing opportunities to receive the initial vaccination and doctors' suggestions to avoid vaccination. This study combined qualitative and quantitative methods to identify several factors associated with COVID-19 vaccine hesitancy among hemodialysis patients. These results will be useful during future pandemics. • We examined the COVID-19 vaccine hesitancy among Japanese hemodialysis patients. • Among 1086 hemodialysis patients at 36 facilities, 54 (5.0 %) were unvaccinated. • A history of anaphylaxis and annual influenza vaccination were associated factors. • Unvaccinated housemates and using X were also newly identified associated factors. • We also found other reasons for the hesitancy by a quantitative method (interview).