Racial and ethnic disparities in COVID-19 vaccination: a systematic review and meta-analysis.

BACKGROUND: This study aimed to systematically review and synthesize the evidence on the relationship between race/ethnicity and COVID-19 vaccine uptake in the general population. METHODS: A comprehensive search of relevant electronic databases was conducted in May 2024 and updated in December 2024. Original research studies comparing COVID-19 vaccine uptake or vaccination rates in racial and ethnic minority populations with those of non-Hispanic White populations were eligible for inclusion. A descriptive synthesis of findings was presented in both narrative and tabular formats. Bayesian random-effects meta-analysis was performed to estimate pooled adjusted relative risk ratios (RRs) and their 95% credible intervals (CrIs) for COVID-19 vaccine uptake across racial and ethnic groups. Posterior distributions were also examined to explore patterns of disparities. RESULTS: A total of 30 studies (21 cross-sectional and 9 cohort) were included in the systematic review, of which 10 studies were eligible for meta-analysis. Most studies were conducted in the United States and the United Kingdom. The majority of the studies reported that racial and ethnic minority groups, including Black, Hispanic, and Other/Mixed racial groups, had lower COVID-19 vaccination rates compared to White populations. Meta-analysis results showed that Black individuals were 13% less likely to be vaccinated (RR: 0.87, 95% CrI: 0.81-0.93), and those of Mixed race were 7% less likely (RR: 0.93, 95% CrI: 0.90-0.97), compared to White individuals. For single-dose uptake, Black individuals were 16% less likely to be vaccinated than White individuals (RR: 0.84, 95% CrI: 0.76-0.92), representing the lowest pooled RR among all groups. Posterior distributions confirmed consistent disparities in vaccine uptake for Black and Mixed race populations across dose categories. CONCLUSION: Most of the studies reported that racial and ethnic minority groups had lower rates of COVID-19 vaccination compared to White populations. Bayesian effect estimates reinforced these disparities for Black and Mixed race minority groups. While no significant differences were found for Asian, Hispanic, and Other race groups, wide credible intervals in some subgroups suggest the need for further research to explore potential contextual and regional variations not captured in the studies.