Chronic Health Conditions and Uptake of COVID-19 Testing and Vaccination Among Native Americans in Oklahoma in the RADx-UP Consortium

INTRODUCTION: American Indian/Alaska Native (AI/AN) individuals were disproportionately affected by the COVID-19 pandemic. We aimed to evaluate whether the presence of chronic health conditions (CHC) impacted COVID-19 testing and vaccination for AI/AN people in Oklahoma. METHODS: We pooled survey data that included adult AI/AN participants weighted using the 2022 American Community Survey. We used modified Poisson regression to estimate prevalence proportion ratios (PPR) and 95% confidence intervals (CI) accounting for weighting, multiple imputation, and confounders to determine whether access to COVID-19 testing and vaccine uptake differed by CHC status. RESULTS: Among the 1,139 participants, 62.6% reported being diagnosed with a CHC. The majority reported being tested for COVID-19 (80.6%) and that testing access was easy (81.7%). We observed no association between CHCs and being tested (Adjusted PPR: 1.08, 95% CI: 0.97, 1.19) or testing access (Adjusted PPR: 1.08, 95% CI: 0.95, 1.21). Over half (57%) of participants received a COVID-19 vaccine. Among unvaccinated individuals, 9.7% reported they were likely to get a vaccine. While we observed no association between CHCs and vaccine status (Adjusted PPR: 1.08, 95% CI: 0.90, 1.27), unvaccinated individuals with a CHC reported they were more likely to get a vaccine compared to individuals with no CHC (Adjusted PPR: 1.81, 95% CI: 1.01, 2.62). DISCUSSION: The AI/AN population is at higher risk of developing CHC, which increases the risk for severe COVID-19. Thus, evaluating barriers to accessing testing and vaccines is important to improve outcomes. This analysis is important in supporting programs for seasonal epidemics and future pandemics. TRIAL REGISTRATION NUMBERS: NCT04870307, NCT05236270.