Vaccination against COVID-19 and socioeconomic inequalities: A cross-sectional study in Ecuador

BACKGROUND: Equity in vaccination against COVID-19 is a public health concern. The objective of this study was to analyze socioeconomic inequalities related to vaccination for the first and second doses from primary series against COVID-19 in Ecuador. METHODS: Secondary database study in 12,743,507 respondents from 15 years and over. The COVID-19 section of the National Survey of Employment, Unemployment and Underemployment (ENEMDU) was analyzed. Socioeconomic characteristics and vaccination against COVID-19 were associated with the at least one dose and second dose. Poisson regressions for complex samples were obtained. RESULTS: As of the date of the survey, 87.3% of the sample (95% CI 86.7%-87.8%) had received at least one vaccine against COVID-19. A lower probability of having received at least one vaccine against COVID-19 was found in rural areas (PR 0.82, 95% CI 0.74–0.91), indigenous population (PR 0.43, 95% CI 0.29–0.64), no level of education (PR 0.25, 95% CI 0.14–0.43), and the lowest economic income (PR 0.42, 95% CI 0.35–0.52). A significantly lower probability of vaccination with two or more doses was found in rural vs urban area (PR 0.88, 95% CI 0.80–0.96), women vs men (PR 0.85, 95% CI 0.77–0.91), indigenous population vs white (PR 0.44, 95% CI 0.33–0.59) and individuals in the lowest income quartile vs highest income quartile (PR 0.48, 95% CI 0.42–0.55). Underemployment, population economically inactive (PR 0.77, 95% CI 0.67–0.88 and PR 0.71, 95% CI 0.61–0.83) and individuals with no level of education (PR 0.39, 95% CI 0.27–0.58) also were less likely to complete the primary phase of vaccination compared with individuals in the highest income quartile, employment and postgraduate level of education. CONCLUSIONS: There were socioeconomic inequalities with the primary series of vaccine against COVID-19, with a greater disadvantage for rural residents, women, indigenous populations, lower economic income and lower levels of education.