Uptake and Factors Associated With COVID-19 Vaccination Among 3,779,733 Adults Living With and Without Diabetes: A Population Cohort Study in a Universal Health-care Setting
Bibliographic record
Abstract
OBJECTIVES: Our aim in this study was to assess COVID-19 vaccine uptake among adults with and without diabetes and the factors associated with vaccination in people with diabetes. METHODS: This retrospective, population-based cohort study included all adults living in Alberta, Canada, on December 14, 2020, the date COVID-19 vaccines became available. Individual diabetes status was determined between April 1, 2002 and December 14, 2020, using a validated algorithm. Individuals were followed until March 31, 2022. The primary outcome was full vaccination, as defined by the manufacturer. Descriptive statistics were used to compare vaccination status among people with and without diabetes. Unadjusted and multivariable-adjusted Cox proportional hazards models were applied to assess factors associated with full vaccination uptake. RESULTS: Among the 3,779,733 adults (49.7% women; mean age 47.2±18.2 years) included in the study, 9.8% had diabetes. A higher proportion of people with diabetes, compared to those without diabetes, were fully vaccinated (82.5% vs 73.1%, p<0.001; men: adjusted hazard ratio [aHR] 1.34, 95% confidence interval [CI] 1.33 to 1.35; women: aHR 1.23, 95% CI 1.22 to 1.24). In people with diabetes, being 65 to 74 years old (men: aHR 1.21, 95% CI 1.16 to 1.26; women: aHR 1.22, 95% CI 1.16 to 1.27) and statin use (men: aHR 1.28, 95% CI 1.27 to 1.30; women: aHR 1.24, 95% CI 1.22 to 1.26) were associated with full vaccination, whereas lower socioeconomic status (men: aHR 0.82, 95% CI 0.81 to 0.84 for quintile 5; women: aHR 0.80, 95% CI 0.79 to 0.82 for quintile 5), rural residence (men: aHR 0.86, 95% CI 0.85 to 0.87; women: aHR 0.87, 95% CI 0.85 to 0.92), higher number of comorbidities (men: aHR 0.95, 95% CI 0.94 to 0.96; women: aHR 0.98, 95% CI 0.97 to 0.99), higher glycated hemoglobin level (men: aHR 0.44, 95% CI 0.43 to 0.45; women: aHR 0.50, 95% CI 0.49 to 0.51), and insulin use (men: aHR 0.89, 95% CI 0.87 to 0.91; women: aHR 0.89, 95% CI 0.87 to 0.91) were associated with lower vaccination uptake. CONCLUSIONS: People with diabetes had high COVID-19 vaccination uptake. Further work is needed to better understand the system- and individual-based facilitators of, and barriers to, vaccine uptake to inform future public health vaccine-based interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".