How urban versus rural residency relates to COVID-19 vaccine hesitancy: A large-scale national Chinese study

Jian Wu; Zhanlei Shen; Quanman Li; Clifford Silver Tarimo; Meiyun Wang; Jianqin Gu; Wei Wei; Xinyu Zhang; Yanli Huang; Mingze Ma; Dongyang Xu; Theodora Ojangba; Yudong Miao

doi:10.1016/j.socscimed.2023.115695

How urban versus rural residency relates to COVID-19 vaccine hesitancy: A large-scale national Chinese study

Soc Sci Med. 2023 Mar:320:115695. doi: 10.1016/j.socscimed.2023.115695. Epub 2023 Jan 18.

Authors

Jian Wu¹, Zhanlei Shen¹, Quanman Li¹, Clifford Silver Tarimo², Meiyun Wang³, Jianqin Gu⁴, Wei Wei³, Xinyu Zhang⁵, Yanli Huang⁶, Mingze Ma¹, Dongyang Xu¹, Theodora Ojangba¹, Yudong Miao⁷

Affiliations

¹ Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China.
² Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China; Department of Science and Laboratory Technology, Dar es salaam Institute of Technology, Dar es Salaam, Tanzania.
³ Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, People's Republic of China.
⁴ School of Medicine, Southern University of Science and Technology, Guangdong, People's Republic of China.
⁵ School of Public Health, Tianjin Medical University, Tianjin, People's Republic of China.
⁶ Manage and service Center of Wuhou Medical Institutes, Sichuan, People's Republic of China.
⁷ Department of Health Management, College of Public Health, Zhengzhou University, Henan, People's Republic of China; Henan Province Engineering, Research Center of Health Economy & Health Technology Assessment, Zhengzhou, Henan, People's Republic of China. Electronic address: meldon@zzu.edu.cn.

Abstract

Rationale: Although urban-rural residency has been shown to influence individual COVID-19 vaccine hesitancy, the differences between urban and rural China have yet to be uncovered.

Objective: This study aims to assess the current prevalence and factors associated with COVID-19 vaccine hesitancy in urban and rural areas and explore whether the rural versus urban residency is associated with COVID-19 vaccine hesitancy.

Methods: A national, cross-sectional, online survey among Chinese urban and rural adults (≥18 years old) was conducted from 6th to August 9, 2021. A questionnaire was used to collect data on sociodemographic factors, perceptions of the COVID-19 pandemic and vaccination status. A multivariable logistic regression model was used to identify the factors that influence COVID-19 vaccine hesitancy. Propensity score matching (PSM) analysis was performed to explore the association between urban versus rural residency and COVID-19 vaccine hesitancy.

Results: In total, 29,925 participants (80.56% urban participants) were recruited. Urban participants had a higher COVID-19 vaccine hesitancy than their rural counterparts (9.39% vs. 4.26%). After adjusting for potential confounders, we found that COVID-19 vaccine hesitancy among females was lower than that in males in both urban (aOR = 0.78, 95% CI [0.69-0.88]) and rural areas (aOR = 0.54, 95% CI [0.39-0.75]). The lack of trust towards vaccine producers was found to be associated with vaccine hesitancy among the urban participants (aOR = 2.76, 95% CI [2.22-3.43]). The rural floating population had a lower COVID-19 vaccine hesitancy than the rural permanent residents (aOR = 0.58, 95% CI [0.42-0.80]). PSM analysis revealed a 2.38% difference in COVID-19 vaccine hesitancy between urban and rural participants.

Conclusions: Urban participants were more hesitant to receive the COVID-19 vaccine than rural participants. Priority should be placed on boosting confidence in the healthcare system to reduce COVID-19 vaccine hesitancy among urban residents. Furthermore, we advocate for extra incentives and vaccination education for rural permanent residents.

Keywords: COVID-19 vaccine hesitancy; China; Propensity score matching; Urban versus rural residency.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
COVID-19 Vaccines
COVID-19*
Cross-Sectional Studies
Female
Humans
Internship and Residency*
Male
Pandemics
Vaccination

Substances

COVID-19 Vaccines