Predictors of COVID-19 vaccination status: a nationwide linkage study in Czechia

OBJECTIVES: The evidence on coronavirus disease 2019 (COVID-19) vaccine uptake in Central and Eastern Europe remains sparse. We examined predictors of COVID-19 vaccination status in Czechia, using linkage of multiple routine nationwide datasets on objective measures of both vaccination and its predictors. METHODS: We used linked administrative data on 6 398 768 individuals aged 26 and older alive on 31 December 2023. Individual-level data were linked across national registries from the Infectious Diseases Information System, National Health Information System, the National Registry of Reimbursed Health Services, and the Ministry of Labour and Social Affairs. RESULTS: The prevalence of unvaccinated status was 22.4%; after multivariable adjustment it was associated with all examined characteristics (age, sex, comorbidity index, registration with a general practitioner (GP), socioeconomic status, unemployment, and district of residence). The prevalence of unvaccinated status among individuals defined by the lowest quintile of income receiving social benefits was 42.1%, and the multivariable adjusted odds ratio (OR) was 3.91 (95% CI 3.87-3.96) compared to the highest quintile; the adjusted OR among unemployed vs. employed subjects was 1.52 (95% CI 1.51-1.53). Higher morbidity index and being registered with a GP were associated with lower odds of unvaccinated status. CONCLUSIONS: These results suggest substantial socioeconomic inequalities in objectively recorded vaccination status.