Author ORCID Identifier


Date of Award

Spring 5-12-2023

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Ya-Hui Yu

Second Advisor

Hannah Reses

Third Advisor

Mary Lu Meng


As of March 2022, only 47% of healthcare personnel (HCP) in U.S. long-term care facilities (LTCFs) have received a COVID-19 booster dose, despite having access to the booster two months before the general population. The slower uptake of COVID-19 boosters among HCP may result from vaccine hesitancy and socioeconomic challenges, which are factors that vary across urbanicity. As previous studies have found lower completion of primary COVID-19 vaccine series among rural communities, it is important to examine if booster uptake vary among HCP, which could help inform where strategies to increase booster uptake are most needed. Using COVID-19 booster data from CDC’s National Healthcare Safety Network (NHSN), we quantified the urbanicity (urban, suburban, rural) disparities of HCP booster coverage in LTCFs (n=14,380) between January and March 2022 and examined if these urbanicity disparities vary by proportions of uninsured individuals of the counties where LTCFs are located. A generalized estimating equations (GEE) model was used to obtain prevalence ratios (PR) and 95% confidence intervals (CI) for comparisons of the average percentage of HCP booster dose by urbanicity. Urban LTCFs had higher HCP booster coverage for all reporting weeks than rural LTCFs (PR: 1.24, 95% CI: 1.21, 1.26), with differences becoming larger across the study period. When stratified by county-level uninsured proportions, the urbanicity disparity persists among low and moderate strata. While there was no urbanicity disparity in HCP booster uptake found among LTCFs located in counties with high percentages of uninsured individuals, HCP booster coverage was lower than the national average for these facilities. With the end of the federal COVID-19 emergency declarations in May 2023, there may be additional barriers to accessing COVID-19 boosters for the uninsured, potentially worsening HCP booster uptake and widening coverage disparities if unaddressed. Initiatives to increase booster dose coverage should be highly prioritized among HCP in rural LTCFs and all LTCFs located in counties with high proportions of uninsured individuals to reduce booster disparities.


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