Vaccine-Preventable Conditions: Disparities in Hospitalizations Affecting Rural Communities in the Southeast United States

Vaccinations are among the most effective means of preventing hospitalizations related to infections. Despite this, high hospitalization rates for vaccine-preventable diseases strain available healthcare resources and imply deficiencies in primary care. Barriers to vaccinations exist, such as the recent pandemic, vaccine hesitancy, misinformation, and access to care. This study analyzes hospitalization rates due to vaccine-preventable conditions and identifies factors contributing to an increase in these rates in the southeast United States. This study used data from four different data sources. The data covers four pre-pandemic years (2016 to 2019) and the pandemic period (2020 to 2022). The analysis categorized the numbers and rates of hospitalizations for conditions with an available preventative vaccine across three age groups: pre-school aged children, school-aged children, and adults. Comparisons between school- versus non-school-mandated vaccines and a focus on differences between rural versus urban communities, as well as demographic characteristics (i.e., gender, race, and ethnicity), are included. Chi-squared tests were used to assess differences in this descriptive part of the analysis. Linear multiple regression was used to examine the independent influence of geographic location while accounting for potential longitudinal trends and the dimensions of the SVI, including socioeconomic status, household composition, disability, minority status and language, and household type and transportation. The dataset included data from 22,797,826 inpatient episodes, including 32,358 for which the principal reason for hospitalization was a vaccine-preventable condition, not including COVID-19. The analysis shows a consistent pattern characterized by higher rates of hospitalization for counties classified as rural. The pattern holds for preschool age ( p < 0.001), school age ( p = 0.004), and adults ( p = 0.009). The differences are statistically significant in the white population ( p = 0.008); in pre-school children, school-age children, and adults ( p < 0.001); in females ( p = 0.08 in pre-school, and p = 0.013 in adults); and black adults ( p = 0.02). The regression results confirmed the findings of the descriptive analysis, indicating significantly higher rates in rural communities. Finally, the regression analysis also showed significantly higher rates associated with greater social vulnerability. This study highlights gaps in vaccination opportunities. These gaps can be seen geographically and in terms of social vulnerability, affected by factors such as poverty, language barriers, household composition, and access to care. Hospitalizations due to immunizable diseases were found to be higher in rural areas, particularly among adults. Communities with a high SVI show a significant increase in hospitalization rates. Community-engaged vaccination outreach programs and state policies could improve vaccination rates, and therefore, public health in rural areas, reducing hospitalizations, and lowering infectious disease risks in these areas.